Cristina Campanale

Process View and Cost Management of a New Surgery Technique in Hospital

Purpose – The purpose of this paper is to analyze the potentiality in the application of process analysis and activity-based costing (ABC) in a healthcare setting to produce usable, useful and correct information on resource consumption and processes. The paper aims to analyze changes applied to the traditional costing model in order to represent the work flow of the organization and the related additional information usable by decision makers at different levels. In particular, the paper is focused on economic analysis related to the introduction of a new surgical technique in healthcare. Design/methodology/approach – An empirical case study is developed in a Tuscan hospital from September 2005 to March 2006, data being collected through interviews to employees and direct observations. Findings – Several factors are found to be critical in such a process analysis and in an ABC implementation in healthcare. First, the need to ground the development of the model structure on the specific characteristics of the organizational setting and the clinical work performed. Second, a problem of culture and language, because professionals have difficulties in understanding the language of activities, and they cannot accept a model designed to measure their work; therefore, some resistances may occur. Third, the constraint of information; in fact more precise estimation may be limited by the information available, as in this case. Research limitations/implications – The paper provides a framework for future research. The replication of the methodology in other hospitals, in order to test the validity of the model and to compare results, can be interesting and another can be the analysis of benefits that the application of the system can provide (in terms of improved efficiency) through a longitudinal analysis. Originality/value – The paper contributes to the field study of ABC and process analysis in healthcare. The original contribution of the model lies in the classification of activities in a hierarchy across the organization, which allows a more precise identification of cost driver; and in the “hybrid” nature (a combination of cost centres and activities) of the model. The latter allows one to identify a “full cost” of the patient.

Time-driven activity-based costing to improve transparency and decision making in healthcare

Purpose - – The purpose of this paper is to discuss the potentialities of innovative accounting tools in supporting “transparency” and “resource allocation” in public hospitals, by describing the implementation of a pilot project of time-driven activity-based costing (TDABC). Design/methodology/approach - – An interventionist research (IR) approach has been adopted: two medical doctors, three financial controllers and three researchers were involved. Collection of data used to implement the accounting model is based on hospital databases and interviews. Findings - – The information produced may allow a higher coherence between resources and activities. TDABC may enhance transparency and support decisions toward a better organization of work and an informed allocation of resources. Research limitations/implications - – Further studies are required to analyze decisions following the implementation of the TDABC model. Originality/value - – The accounting literature lacks case studies describing the application of TDABC in hospital settings, despite its good informative potentialities and the limited investment required to introduce TDABC. Moreover, the use of the IR approach and the involvement of medical doctors may help to get coherence between accounting data and clinical work and may support the further diffusion and development of this costing model in hospitals.

Esternalizzazione e centralizzazione dei processi di approvvigionamento: risultati e criticità dell'esperienza degli Estav nella sanità toscana

Le opportunita ed i vantaggi derivanti dall’esternalizzazione e dalla centralizzazione dei processi aziendali, evidenziati in letteratura nel contesto privato, sono riscontrabili anche nel contesto sanitario pubblico? L’articolo si propone di compiere una prima valutazione dei risultati raggiunti in Toscana con l’introduzione degli ESTAV, la cui istituzione e avvenuta per razionalizzare, a livello sovra-aziendale, le funzioni tecnicoamministrative ed in particolare gli approvvigionamenti. Valutando i risultati raggiunti in termini di efficienza e di efficacia, viene evidenziato come tale esperienza presenti, pur con ampi spazi di miglioramento, risultati indubbiamente positivi e assimilabili a quelli presenti nel contesto privato.