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Sustainability and Resilience in Health: The Role of Performance Management
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Sustainability and Resilience in Health: The Role of Performance Management

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Occupational Safety and Health".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 38659

Special Issue Editors

Dr. Milena Vainieri

E-Mail Website
Guest Editor
Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant’Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127 Pisa, Italy
Interests: performance evaluation system; performance management systems; governance mechanism; variation management and health system governance
Dr. Laura Rosella

E-Mail Website
Guest Editor
Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th Floor, Toronto, ON M5T3M7, Canada
Interests: population health; analytics; health system sustainability; equity; prevention; health services research; epidemiology
Special Issues, Collections and Topics in MDPI journals
Dr. Guido Noto

E-Mail Website
Assistant Guest Editor
Department of Economics, University of Messina, 98122 Messina, Italy
Interests: performance management for health systems, organizations and services
Dr. Francesca Ferré

E-Mail Website
Assistant Guest Editor
Management and Health Laboratory, Institute of Management and Department EMbeDS, Sant’Anna School of Advanced Studies of Pisa, Piazza Martiri della Libertà 27, 56127, Pisa, Italy
Interests: healthcare system governance; performance management in healthcare; health technology assessment and outcome research

Special Issue Information

Dear Colleagues,

Health systems face challenges which are inherent to care demand and supply evolution (i.e., demographic change, new technologies) or are the results of unexpected occurrences originating outside the health system such as economic shocks or epidemic outbreaks. Both challenges often require a paradigm shift in governance and organization, financing and resource allocation, accountability frameworks, as well as public health system responses.

Consistently, scholars recently re-defined the concept of value in healthcare, highlighting its different dimensions: allocative value, personal value, technical value, and societal value. Performance management systems are thus called to embrace this new concept.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) seeks to advance our understanding of managerial strategies, governance mechanisms, as well as performance management systems that can be applied to cope with different scenarios.

Specific themes include (but are not limited to) the following:

  • How performance measurement systems evolve, or should evolve, to support decision-makers in dealing with the emergent challenges. What are the implications for information systems?
  • How does the organization and management of different health systems capture the health and social needs of populations?
  • What could be the factors that help to build resilience, making it easier for health systems to respond effectively to future challenges?
  • How can embracing the multifaceted elements of value in performance management lead to a sustainable health system?
  • What are the intended or unintended consequences of the different strategies health systems and organizations implemented for the evolving scenarios?

Papers dealing with one or more of the current challenges of healthcare systems are welcome. In particular, we are open to papers presenting research at micro, meso, and macro levels. For this Special Issue we will balance empirical research, case studies, as well as theoretical, methodological, or position papers.

We will accept manuscripts from different disciplines, including management, accounting, epidemiology, health impact assessment, and crisis management.

Dr. Milena Vainieri
Dr. Laura Rosella
Dr. Guido Noto
Dr. Francesca Ferré
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • performance management systems
  • resource allocation
  • variability (or variation) management
  • value-based healthcare
  • governance models
  • governance mechanisms
  • population health management
  • artificial intelligence and big data
  • innovation management
  • healthcare system resilience

Published Papers (9 papers)

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Editorial

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10 pages, 534 KiB  
Editorial
A Performance Management System in Healthcare for All Seasons?
by Milena Vainieri, Guido Noto, Francesca Ferre and Laura C. Rosella
Int. J. Environ. Res. Public Health 2020, 17(15), 5590; https://doi.org/10.3390/ijerph17155590 - 03 Aug 2020
Cited by 22 | Viewed by 6665
Abstract
Health systems face challenges which are inherent to care demand and supply evolution (i.e., demographic change, new technologies) or are the results of unexpected occurrence originating outside the health system, such as economic shocks or epidemic outbreaks. Both challenges often require a paradigm [...] Read more.
Health systems face challenges which are inherent to care demand and supply evolution (i.e., demographic change, new technologies) or are the results of unexpected occurrence originating outside the health system, such as economic shocks or epidemic outbreaks. Both challenges often require a paradigm shift in governance and organization, financing and resource allocation, accountability frameworks, as well as public health system responses. Based on key reviews and seminal papers of performance management, public health, sustainability and resilience, the article presents three emerging challenges for performance management systems in healthcare: i) the inclusion of the population approach; ii) the measurement and consideration of the multi-facets concepts of value; iii) the importance of resilience and sustainability. Performance management systems need to evolve to cope with this changing scenario. The article sheds light on uncovered areas by performance management, and it proposes a research agenda for scholars of both performance management and health service research. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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Research

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14 pages, 1412 KiB  
Article
Integrating Key Nursing Measures into a Comprehensive Healthcare Performance Management System: A Tuscan Experience
by Chiara Barchielli, Anne Marie Rafferty and Milena Vainieri
Int. J. Environ. Res. Public Health 2022, 19(3), 1373; https://doi.org/10.3390/ijerph19031373 - 26 Jan 2022
Cited by 3 | Viewed by 3796
Abstract
This paper addresses the evaluation of nursing quality and safety beyond nursing tasks in specific healthcare settings and sets it in a context that conveys the sense of complexity and multifaceted nature of the contribution that nursing makes to the whole system. The [...] Read more.
This paper addresses the evaluation of nursing quality and safety beyond nursing tasks in specific healthcare settings and sets it in a context that conveys the sense of complexity and multifaceted nature of the contribution that nursing makes to the whole system. The paper describes research conducted in Tuscany during 2019 involving regional managers and heads of nursing departments. This research has led to the development of an integrated evaluation framework through focus groups and consensus process with the latter, which includes Performance Organizational climate data, Patient-Reported Experience Measures (PREMs), and Patient-Reported Outcome Measures (PROMs). This integrated framework aims at both making sense of extant measures as key performance indicators shared among different professionals while recognizing the important role of nursing care by adding specific measures and can be seen as a tool that boosts the sense of “teamness” in healthcare. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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17 pages, 1805 KiB  
Article
Resilience Testing of Health Systems: How Can It Be Done?
by Heather L. Rogers, Pedro Pita Barros, Jan De Maeseneer, Lasse Lehtonen, Christos Lionis, Martin McKee, Luigi Siciliani, Dorothea Stahl, Jelka Zaletel and Dionne Kringos
Int. J. Environ. Res. Public Health 2021, 18(9), 4742; https://doi.org/10.3390/ijerph18094742 - 29 Apr 2021
Cited by 11 | Viewed by 4718
Abstract
The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach [...] Read more.
The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health systems. We develop a methodology for a test that is balanced in terms of standardization and system-specific characteristics/needs. We specify how to work with diverse stakeholders from the health ecosystem via participatory processes to assess and identify recommendations for health system strengthening. The proposed resilience test toolkit consists of “what if” adverse scenarios, a menu of health system performance elements and indicators based on an input-output-outcomes framework, a discussion guide for each adverse scenario, and a traffic light scorecard template. The five phases of implementation include Phase 0, a preparatory phase to adapt the toolkit materials; Phase 1: facilitated discussion groups with stakeholders regarding the adverse scenarios; Phase 2: supplemental data collection of relevant quantitative indicators; Phase 3: summarization of results; Phase 4: action planning and health system transformation. The toolkit and 5-phased approach can support countries to test resilience of health systems, and provides a concrete roadmap to its implementation. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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18 pages, 1589 KiB  
Article
Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia
by Laura Esteve-Matalí, Ingrid Vargas, Franco Amigo, Pere Plaja, Francesc Cots, Erick F. Mayer, Joan-Manuel Pérez-Castejón and María-Luisa Vázquez
Int. J. Environ. Res. Public Health 2021, 18(6), 3224; https://doi.org/10.3390/ijerph18063224 - 20 Mar 2021
Cited by 6 | Viewed by 2731
Abstract
Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. [...] Read more.
Clinical coordination between primary (PC) and secondary care (SC) is a challenge for health systems, and clinical coordination mechanisms (CCM) play an important role in the interface between care levels. It is therefore essential to understand the elements that may hinder their use. This study aims to analyze the level of use of CCM, the difficulties and factors associated with their use, and suggestions for improving clinical coordination. A cross-sectional online survey-based study using the questionnaire COORDENA-CAT was conducted with 3308 PC and SC doctors in the Catalan national health system. Descriptive bivariate analysis and logistic regression models were used. Shared Electronic Medical Records were the most frequently used CCM, especially by PC doctors, and the one that presented most difficulties in use, mostly related to technical problems. Some factors positively associated with frequent use of various CCM were: working full-time in integrated areas, or with local hospitals. Interactional and organizational factors contributed to a greater extent among SC doctors. Suggestions for improving clinical coordination were similar between care levels and related mainly to the improvement of CCM. In an era where management tools are shifting towards technology-based CCM, this study can help to design strategies to improve their effectiveness. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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14 pages, 599 KiB  
Article
The Challenges of Hospitals’ Planning & Control Systems: The Path toward Public Value Management
by Sabina Nuti, Guido Noto, Tommaso Grillo Ruggieri and Milena Vainieri
Int. J. Environ. Res. Public Health 2021, 18(5), 2732; https://doi.org/10.3390/ijerph18052732 - 08 Mar 2021
Cited by 7 | Viewed by 2962
Abstract
In the last decades, public management has been subjected to a shift from the New Public Management (NPM) paradigm to the Public Value Management (PVM) one. Thus, management practices such as Planning and Control (P&C) systems have been called to evolve accordingly. The [...] Read more.
In the last decades, public management has been subjected to a shift from the New Public Management (NPM) paradigm to the Public Value Management (PVM) one. Thus, management practices such as Planning and Control (P&C) systems have been called to evolve accordingly. The health care sector has not escaped this process. This paper focuses on the evolution of hospitals’ P&C systems to support the paradigm shift from the NPM paradigm to the PVM one. In particular, the paper aims at exploring whether hospitals’ P&C systems in Italy evolved, or are evolving, consistently with PVM and what are the expected benefits related to such a paradigm switch. To address the research aim, the paper is based on a review of scientific and grey literature and the case study of the diabetic-foot pathway in an Italian Regional Healthcare System. The results of this study show that the current P&C systems in Italian hospitals are not yet designed to support the shift toward the PVM approach and are still mainly focused on financial aspects and intra-organizational dynamics. Combining traditional P&Cs with performance measures assessing the system’s outcomes may support hospitals in aligning their goals with the health system they are operating within and, therefore, P&C systems may represent an important driving force toward change. Such results provide suggestions for both practitioners and academics on how to adapt P&C systems to better support the implementation of current strategies of the public sector. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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10 pages, 309 KiB  
Article
Learning from Excellence to Improve Healthcare Services: The Experience of the Maternal and Child Care Pathway
by Alice Borghini, Ilaria Corazza and Sabina Nuti
Int. J. Environ. Res. Public Health 2021, 18(4), 1481; https://doi.org/10.3390/ijerph18041481 - 04 Feb 2021
Cited by 7 | Viewed by 2478
Abstract
The ability to deal with adversity and the resilience of people and groups are shown to depend positively on the tendency to nurture positivity. Therefore, the aim of this study is to evaluate whether Learning from Excellence (LfE) can be an effective method [...] Read more.
The ability to deal with adversity and the resilience of people and groups are shown to depend positively on the tendency to nurture positivity. Therefore, the aim of this study is to evaluate whether Learning from Excellence (LfE) can be an effective method to manage systematic health systems, when transparent disclosure and benchmarking of data are adopted in performance evaluation. This study consists of a quantitative and a qualitative phase. In the former, maternal care is investigated at the regional level, starting from performance data and indicators of the maternity pathway referred to 98 healthcare providers in 10 Italian regions, that share the same evaluation system. The second phase investigates qualitatively the organizational determinants and the experience of professionals involved in the pathway, through the organization of on-site workshops. We identified the seven best practices among the 42 units of analysis. Communication, trust and shared goals among health professionals involved in the pathway emerged as core themes from the qualitative analysis. This study confirms that LfE under the conditions of benchmarking assessment and transparent disclosure of data can be implemented systematically in management practice, in order to boost health personnel’s resilience and, in general, the organizational climate in the working environment. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
12 pages, 548 KiB  
Article
Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety
by Davide Ferorelli, Biagio Solarino, Silvia Trotta, Gabriele Mandarelli, Lucia Tattoli, Pasquale Stefanizzi, Francesco Paolo Bianchi, Silvio Tafuri, Fiorenza Zotti and Alessandro Dell’Erba
Int. J. Environ. Res. Public Health 2020, 17(17), 6267; https://doi.org/10.3390/ijerph17176267 - 28 Aug 2020
Cited by 16 | Viewed by 3278
Abstract
Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the [...] Read more.
Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor–patient alliance. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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Other

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22 pages, 10083 KiB  
Systematic Review
The Evolution of Balanced Scorecard in Healthcare: A Systematic Review of Its Design, Implementation, Use, and Review
by Frida Betto, Alberto Sardi, Patrizia Garengo and Enrico Sorano
Int. J. Environ. Res. Public Health 2022, 19(16), 10291; https://doi.org/10.3390/ijerph191610291 - 18 Aug 2022
Cited by 9 | Viewed by 6119
Abstract
During the last few years, the interest in performance measurement increased within the healthcare sector. Due to the COVID-19 pandemic, healthcare systems needed to boost performance measurement systems to become more resilient and improve their capability in monitoring key performance indicators. Since the [...] Read more.
During the last few years, the interest in performance measurement increased within the healthcare sector. Due to the COVID-19 pandemic, healthcare systems needed to boost performance measurement systems to become more resilient and improve their capability in monitoring key performance indicators. Since the 1990s, the Balanced Scorecard (BSC) model has been widely used among private and public organizations as it is the most adopted model to measure performance. The current paper aims at understanding the evolution of BSC in healthcare. The systematic literature review has been carried out by searching keywords according to PRISMA guidelines. By analyzing papers through one classification of BSC adoption phases, the results reveal that studies focused mainly on the BSC design process, rather than BSC implementation, use, or review. However, there is no agreement about the perspectives to be adopted in healthcare. Concerning BSC implementation and use, on one side especially leadership, culture and communication enable the BSC implementation. On the other side, monitoring and strategic decision-making are the most widespread objectives for using BSC. Concerning BSC review, however, the paper highlights a need for additional research. Finally, the paper provides further research opportunities concerning the phases suitable for implementing a BSC in healthcare. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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28 pages, 1674 KiB  
Systematic Review
Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics
by Marta Marsilio, Floriana Fusco, Eleonora Gheduzzi and Chiara Guglielmetti
Int. J. Environ. Res. Public Health 2021, 18(7), 3336; https://doi.org/10.3390/ijerph18073336 - 24 Mar 2021
Cited by 13 | Viewed by 4633
Abstract
Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and [...] Read more.
Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and above all, a comprehensive knowledge of the metrics used to assess these outcomes is lacking. To fill this gap, this study aims to systematically review the extant literature to map the methods, tools and metrics used to empirically evaluate co-production in health services. The search took place in six databases: Scopus, Web of Science, Psych INFO, PubMed, Cochrane and CINAHL. A total of 2311 articles were screened and 203 articles were included in the analysis, according to PRISMA guidelines. Findings show that outcomes are mainly investigated through qualitative methods and from the lay actor or provider perspective. Moreover, the detailed categorisation of the quantitative measures found offers a multidimensional performance measurement system and highlights the impact areas where research is needed to develop and test new measures. Findings should also promote improvements in empirical data collection on the multiple faceted co-produced activities and spur the consciousness of the adoption of sustainable co-productive initiatives. Full article
(This article belongs to the Special Issue Sustainability and Resilience in Health: The Role of Performance Management)
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