Emanuele Padovani

Operating room data management: improving efficiency and safety in a surgical block

BackgroundEuropean Healthcare Systems are facing a difficult period characterized by increasing costs and spending cuts due to economic problems. There is the urgent need for new tools which sustain Hospitals decision makers work. This project aimed to develop a data recording system of the surgical process of every patient within the operating theatre. The primary goal was to create a practical and easy data processing tool to give hospital managers, anesthesiologists and surgeons the information basis to increase operating theaters efficiency and patient safety.MethodsThe developed data analysis tool is embedded in an Oracle Business Intelligence Environment, which processes data to simple and understandable performance tachometers and tables. The underlying data analysis is based on scientific literature and the projects teams experience with tracked data. The system login is layered and different users have access to different data outputs depending on their professional needs. The system is divided in the tree profile types Manager, Anesthesiologist and Surgeon. Every profile includes subcategories where operators can access more detailed data analyses. The first data output screen shows general information and guides the user towards more detailed data analysis. The data recording system enabled the registration of 14.675 surgical operations performed from 2009 to 2011.ResultsRaw utilization increased from 44% in 2009 to 52% in 2011. The number of high complexity surgical procedures (≥120 minutes) has increased in certain units while decreased in others. The number of unscheduled procedures performed has been reduced (from 25% in 2009 to 14% in 2011) while maintaining the same percentage of surgical procedures. The number of overtime events decreased in 2010 (23%) and in 2011 (21%) compared to 2009 (28%) and the delays expressed in minutes are almost the same (mean 78 min). The direct link found between the complexity of surgical procedures, the number of unscheduled procedures and overtime show a positive impact of the project on OR management. Despite a consistency in the complexity of procedures (19% in 2009 and 21% in 2011), surgical groups have been successful in reducing the number of unscheduled procedures (from 25% in 2009 to 14% in 2011) and overtime (from 28% in 2009 to 21% in 2011).ConclusionsThe developed project gives healthcare managers, anesthesiologists and surgeons useful information to increase surgical theaters efficiency and patient safety. In difficult economic times is possible to develop something that is of some value to the patient and healthcare system too.

Toward a Framework for Managing High-Risk Government Outsourcing: Field Research in Three Italian Municipalities

Many public sector organizations use outsourcing in an effort to take advantage of a private contractors experience and economies of scale, thereby allowing them to provide high quality public services at a low cost. Although it has received considerable attention in the public policy and management literature for almost three decades, outsourcing has not always achieved a municipalitys goals. To address the strategic and managerial issues of outsourcing, we combine a literature review with data obtained from a field study of three Italian municipalities. The resulting framework can assist public sector managers to determine both the services that are the best candidates for outsourcing, and the issues that must be considered in managing the chosen vendors to guarantee high quality and cost-effective results.

Implementing Change in a Hospital Management Accounting System

A central aspect of the efforts to improve public healthcare systems often is a provider’s management accounting system (MAS). The article focuses on a change effort for a hospital’s MAS. The effort involved implementing low-cost information technology designed to improve efficiency and effectiveness in operating rooms. The article aims to identify and discuss the factors that led to the hospital’s success in achieving improved outcomes at lower costs via the improvement of its MAS. The analysis uses a theoretical framework that can assist managers to identify methods that can help to foster the factors needed for effective change implementation.

E-government, Accountability, and Performance: Best-in-Class Governments in European Union Countries

To what extent do e-government influence accountability and performance in the public sector? Given the growing importance of performance and accountability in government, discussion has not been as robust as it should be regarding the role of e-government in understanding these challenges. Much has been claimed and written about the influence of e-government on the modernization and growth of public sector initiatives in Europe. Little is known, however, about how e-government influences the accountability and performance of governments. The view of e-government proposed in the chapter suggests policy makers to a more careful consideration of performance and accountability pressures that different e-government strategies bring with them. Particularly, the chapter presents a view of both challenges and advantages of implementing e-government strategies, by examining how closely and critically intertwined e-government, performance and accountability are in ten European Union (EU) countries.

Accounting practices in Italian higher education system

Abstract The aim of this paper is to investigate whether the accounting systems and techniques in use in higher education system in Italy allow key users to have useful information for a rational decision-making process. The paper develops on a specific case, the Italian context of state and non-state universities. The research is conducted through a survey addressed to all Italian universities and investigates accounting conditions during the academic year 2008-2009. It reveals the most common approach to the building of the accounting information system and the level of diffusion and development of cost accounting techniques, identifying areas of improvement.

The Use of Financial Indicators to Determine Financial Health of Italian Municipalities

Context: Governments are being pressured by citizens and other stakeholders to improve their efficiency and effectiveness while, at the same time, they are seeing reductions in available resources. This is the result of several waves of New Public Management-style reforms which have developed into the New Public Governance view (Osborne, 2009). At the same time, recent global financial stress challenges the financial sustainability of governments, both at national and local levels.Problem: Financial health is a necessary condition under which governments must operate. Nevertheless, while the literature concentrates on different models of governance within the public sector, there is a lack of research on financial health measurement system.Purpose: In light of this problem, we juxtapose the analysis of financial health measurement systems with Considine’s four governance models applied to the Italian local governments context.Theoretical frameworks: The paper grounds its theoretical frameworks from the literature concerning various governance model types, [Procedural, Corporate, Market, and Network Governance] (Considine, 1999, 2001, 2003) and financial health (Boyett and Giroux, 1978; Downing, 1991; Alijarde and Lopez, 2001).Methodology: Through a multiple case study approach of three Italian local governments we combine documental analysis of compulsory financial statement indicators and interviews with internal key users aimed to understand the effective use of financial indicators to determine financial health in practice. Findings: A local government needs to have a specific set of financial performance indicators attuned to the prevalent governance model used for its services delivery. Originality, value and practical implications: On a theoretical perspective, this study highlights to what extent each governance model requires specific financial health measures, in order to stress that measuring financial health is a contingent issue, which cannot be assessed regardless the prevailing governance setting implemented. Under a practical point of view, this study identifies the features of different types of financial health measurement systems in various governance models.

Municipal Performance Measurement in Practice: Which Factors Matter?

Performance measurement systems have two contrasting facets. On one hand, they assist managers to take rational actions; on the other, they disclose important information to citizens on their “value for money”. For political reasons the latter may prevail over the former, and this can undermine the validity, legitimacy and functionality of performance measurement systems for managerial action (Bouckaert 1993). Departing from the neo institutional theory, the purpose of this paper is to contribute to the understanding of the drivers that affect the use and implementation of managerially oriented performance measurement systems in municipalities, and how these drivers could affect the validity, legitimacy, and functionality of performance measurement itself. A multiple case study approach is used, with extensive document analysis and direct interviews in four municipality (two in Spain and two in Italy), that have successfully implemented performance measurement systems. Findings provide evidence to inform practitioners about the conditions under which the introduction and use of performance measurement systems in municipalities might be successful, identifying the important drivers of a successful implementation effort and help to increase municipal managers’ understanding of the factors that play a role in the successful implementation of a managerially-oriented performance measurement system in a municipal context.

NPM Reforms in Napoleonic Countries: A Comparative Study of Management Accounting Innovations in Greek and Italian Municipalities

ABSTRACT This is a comparative study of the rationale and effects of management accounting innovations in Greek and Italian municipalities, as part of the NPM reform in the public sector. This article aims to understand the extent of adoption of accounting innovations in Greek and Italian municipalities, and the factors affecting the specific techniques in use. The study reports on a survey based on medium-sized and large Italian and Greek municipalities, targeted at public municipalities’ accountants, the users of accounting techniques. The study identifies the intended purposes of NPM reform and, particularly, management accounting innovations, analyzes a set of factors that affect the implementation of management accounting technologies, and discusses determinants and features of such innovation on a comparative perspective.

Challenges in the Comparative Analysis of Local Government Bureaucracy and Performance Measurement: The Case of Italy and the United States

Across the globe, local governments and their brethren regional and national governments, are facing the growing prospect of performance measurement and management (Hatry, 1999, 2006; De Bruijn, 2002; Poister, 2003), performance based budgeting (for example Berman and Wang, 2000), and the general rubric of new public management (OECD, 1990; Hood, 1991, 1995; Osborne and Gaebler, 1992; Pollitt, 1993; Pollitt and Bouckaert, 2000; Guthrie et al. 2005). In essence, these approaches demand greater accountability, in many cases greater data collection and compilation and reporting in order to create a more transparent and more responsive government. Importantly, these new management systems are also critical in facilitating the comparison of governments within and across countries. Extensive research has been conducted over the last two decades on understanding the evolution of performance measurement systems (PMSs), their adoption and, in some cases, their effectiveness, both subjective and objective (see for example Poister, 2003). While some attempt has been made to address cross-national trends in PMSs, very few systemic efforts have been attempted to uncover similarities and differences. This type of analysis may illuminate the importance of different aspects of the adoption and use of performance measurements in local governments across country borders. Progress has been made in understanding challenges in measuring and comparing bureaucracies across countries at the national level (see for example, Van de Walle, 2005, 2006). The next stage or evolution in this area of interest is the comparison of local government performance and bureaucracy. This is particularly important given the continuing push by many international agencies for devolution or decentralization of government functions (for example OECD, 2001). This paper will proceed to address two basic questions. One, an analysis will be undertaken on the methodological challenges of comparing local government bureaucracy across countries. Starting from the existing literature, a methodological framework will be constructed to identify the key variables and options in comparing the local government bureaucracies of countries. Second, the paper will build on this methodological framework and compare the local governments of the United States and Italy. This comparison, that will be carried out being aware of the possible pitfalls which can undermine such cross-national research (Eglene and Dawes, 2006), will be facilitated by the joint surveying of local governments in these countries in the spring of 2007. One of the challenges in comparing local governments are the different set of functional responsibilities encompassed by different levels of government. One must find a way to standardize service delivery responsibilities across different countries and systems. A second challenge is the availability of data, even within a single country, to compare or benchmark performance across countries. A third challenge is the differences in expectations among the population and elected officials as to the role of government and bureaucracy in society. As a matter of facts, one major criticism has been the subjective nature of the comparative indicators (Van de Walle, 2005). Our analysis proceeds by addressing the challenge of compiling comparable data and assessing how even nearly identical survey instruments can lead to challenges in assessing the adoption and use of performance measures across two countries. Using a quantitative analysis, the aim is to contribute to Study Group on Productivity and Qualitys theme of comparisons of public sectors across countries. Questions that will be directly addressed include: What are the challenges in comparing local government bureaucracies across countries? Can instruments be designed to facilitate this comparison? What are the conditions under which PMS is established and succeed? What are the enablers of successful PMS? Does PMS bring to deliver all the desired effects claimed by theory?

Accounting Reform in Italian Universities. Internal Response to Accounting Change

This paper aims to examine the public sector accounting reform in Italy, focusing on universities and addressing the specific aspect of the accounting change from an internal perspective. The study focuses on the question of how universities in Italy responded internally to governmental pressures for accounting reform, and it examines the extent to which universities implemented the new accounting systems based on the accrual accounting introduction and the new budgeting and reporting implementation. This paper makes use of the key elements identified by Lapsley and Pettigrew’s framework (1994) to shed light on accounting change in three Italian universities, and it identifies the key elements that qualify receptive and non-receptive contexts of change in practice.