Giovanni Radaelli

Disaster management: findings from a systematic review

Purpose – The paper aims to discuss a systematic review of the literature about disaster management within the period 1980‐2006.Design/methodology/approach – The research protocol is based on the methodology that is commonly used in healthcare for analysing the literature and provides a state‐of‐art medical discipline. The paper presents both a descriptive analysis and a thematic analysis in order to provide a state‐of‐art of international literature. The research protocol is provided in order to make transparent the review process.Findings – The descriptive analysis highlights the peculiarities of the literature in terms of attention paid during the years, country of provenience and clusters of content of the selected papers. The thematic analysis deepens the content of the papers formalising the state of art.Research limitations/implications – The review considered only academic journals and peer‐reviewed published papers, excluding working papers and books.Practical implications – Through both the anal...

Patient Empowerment and its neighbours: Clarifying the boundaries and their mutual relationships

Patients are increasingly encouraged to become active players in self-care and shared decision-making. Such attention has led to an explosion of terms - empowerment, engagement, enablement, participation, involvement, activation - each having multiple and overlapping meanings. The resulting ambiguity inhibits an effective use of existing evidence. This study addresses this problem by delivering an evidence-based concept mapping of these terms that delineates their boundaries and mutual relationships. We implemented a literature review of contributions associated to patient empowerment, activation, engagement, enablement, involvement, and participation. We implemented a keyword-based strategy collecting contributions published in PubMed database in the 1990-2013 timespan. A total of 286 articles were selected. The results identified three distinct interpretation of patient empowerment, either conceived as a process, an emergent state or as a participative behaviour. Most definitions recognize empowerment as the combination of ability, motivation and power opportunities. A concept mapping for patient empowerment, activation, enablement, engagement, involvement, and participation was then delineated. The concept map consists of two dimensions (nature and focus of concept) and marks distinctions and relationships between the concepts. The resulting concept map paves the way for a number of future research directions that can help improve our understanding of the antecedents and consequences of patient empowerment policies.

IMPLEMENTATION OF EUNETHTA CORE MODEL® IN LOMBARDIA: THE VTS FRAMEWORK

OBJECTIVES This study describes the health technology assessment (HTA) framework introduced by Regione Lombardia to regulate the introduction of new technologies. The study outlines the process and dimensions adopted to prioritize, assess and appraise the requests of new technologies. METHODS The HTA framework incorporates and adapts elements from the EUnetHTA Core Model and the EVIDEM framework. It includes dimensions, topics, and issues provided by EUnetHTA Core Model to collect data and process the assessment. Decision making is instead supported by the criteria and Multi-Criteria Decision Analysis technique from the EVIDEM consortium. RESULTS The HTA framework moves along three process stages: (i) prioritization of requests, (ii) assessment of prioritized technology, (iii) appraisal of technology in support of decision making. Requests received by Regione Lombardia are first prioritized according to their relevance along eight dimensions (e.g., costs, efficiency and efficacy, organizational impact, safety). Evidence about the impacts of the prioritized technologies is then collected following the issues and topics provided by EUnetHTA Core Model. Finally, the Multi-Criteria Decision Analysis technique is used to appraise the novel technology and support Regione Lombardia decision making. CONCLUSIONS The VTS (Valutazione delle Tecnologie Sanitarie) framework has been successfully implemented at the end of 2011. From its inception, twenty-six technologies have been processed.

Intellectual capital and knowledge sharing: the mediating role of organisational knowledge-sharing climate

Healthcare organisations are facing the constant trade off to contain expenditures without sacrificing the quality of patients care. This challenge to do ‘more with less’ induced healthcare executives to heavily invest in innovations activities in order to increase the efficiency of their organisations. By taking an individual-level perspective, our study focuses on knowledge-sharing behaviour among healthcare practitioners as a critical element to continuously improve the performance of healthcare organisations. Specifically we explore the effect of intellectual capital on practitioners’ knowledge-sharing behaviour, and propose organisational knowledge-sharing climate as mediator. We conducted a survey on three healthcare organisations. Our results substantiate the positive link between intellectual capital and knowledge-sharing behaviour, and reveal that organisational knowledge-sharing climate fully mediates this relationship. These findings provide hospital managers with key implications for the management of intellectual capital as a lever to improve the sharing and the diffusion of knowledge among practitioners.

The effect of social capital on exploration and exploitation: Modelling the moderating effect of environmental dynamism

Purpose – The purpose of this paper is to enter the debate on the antecedents of knowledge exploration and exploitation by investigating the role of social capital and environmental dynamisms. The contribution is grounded on existing insights that no empirical evidence exists on the link between social capital and exploration/exploitation behaviors. Design/methodology/approach – The model considers three social capital dimensions – structural, relational and cognitive. It also considers the moderation effect of environmental dynamism on the link between social capital and knowledge exploration and exploitation. Head physicians from Italian hospitals were surveyed using a structured questionnaire. The data set consists of 174 observations, analyzed using seemingly unrelated regression techniques. Findings – This research provides evidence of the positive effect of structural, relational and cognitive social capital on knowledge exploration and exploitation – thus adding to a literature which has thus far c...

Team creativity: A complex adaptive perspective

Purpose – This study aims at narrowing a high level of fragmentation in the knowledge on the topic of team creativity (TC) that plays a fundamental role in enhancing an organizations delivery systems and market position by mapping available knowledge within a proposed framework. Although there is a wealth of knowledge on the topic, this fragmentation as revealed by past research limits the comprehensive understanding of the subject. Design/methodology/approach – A literature review was used to gather evidence about the key concepts in the fields of management, organization and innovation. This evidence is mapped against the backdrop of a complex adaptive perspective, as creativity is perceived as the product of micro-social units within the context of macro-social systems. Findings – The great number of concepts found in literature are organized into a framework that distinguishes relevant inputs that can affect team functioning; relevant mediators for TC; and TC outcomes. The framework is reviewed and discussed within the context of the social systems in which the team is embedded. Originality/value – TC is one of the most fertile research streams within the research field of innovation, and yet it suffers from a fragmentation that limits a deeper level of understanding and the advancement of actionable knowledge from taking place. An integrative theoretical perspective of micro- and macro-social systems gives researchers new insights into the interconnection between the numerous findings already found in the literature and gives a clear direction for future research.

Empowering patients through eHealth: a case report of a pan-European project

BackgroundThis paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, HeartCycle, Empower). However, the heterogeneity of the healthcare systems, of the implemented services and of the target patients, the use of ad-hoc definitions of the salient concepts and the development of small-size experiences have prevented the dissemination of “global” results and the development of cumulative knowledge. The main challenge has been the generation of large-scale evidence from heterogeneous small-size experiences.DiscussionThree lessons have been collectively learnt during the development of the PALANTE project, which involves 9 sites that have implemented different eHealth services for empowering different typologies of patients. These lessons have been refined progressively through project meetings, reviews with the EC Project Officer and Reviewers. The paper illustrates the ten steps followed to develop the three lessons.The first lesson learnt is about how EC-funded projects should develop cumulative knowledge by avoiding self-crafted measures of outcome and by adopting literature-grounded definitions and scales. The second lesson learnt is about how EC-funded projects should identify ambitious, cross-pilot policy and research questions that allow pooling of data from across heterogeneous experiences even if a multi-centre study design was not agreed before. The third lesson learnt is about how EC-funded projects should open their collections of data and make them freely-accessible to the scientific community shortly after the conclusion of the project in order to guarantee the replicability of results and conclusions.SummaryThe three lessons might provide original elements for fuelling the ongoing debate about the capability of the EC to develop evidence-based policies by pooling evidence from heterogeneous, local experiences.

Intellectual Capital and Innovative Work Behaviour: Opening the Black Box

Continuous improvement initiatives have proliferated among manufacturing and services organizations. In this context, knowledge has been claimed to play a key role, as a significant antecedent of an organizations ability to continuously improve its performance. At the same time, attempts to implement knowledge management initiatives prove fruitless if employees are not fully motivated and engaged, and our present understanding of how to promote and facilitate such behaviours remains limited. This study introduces and empirically tests a theoretical model that links intellectual capital dimensions to employees innovative work behaviour and specifically suggests knowledge sharing behaviour among employees as a key mediator. A survey was used to collect data from 135 employees in three healthcare organizations. The results of our structural equation modelling (SEM) analysis indeed support the notion that intellectual capital is conducive to innovative behaviour by means of knowledge sharing among employees. These findings contribute to the understanding of how behavioural factors operate in organizations, highlighting the relevance of a micro-foundation of continuous improvement, and also suggesting some preliminary guidelines that managers in healthcare organizations can apply to promote employee innovative work behaviour.

Promoting a new Practice in hospitals : a qualitative comparative analysis of alternative designs

Hospitals often fail to implement new practices due to an inability to promote their use among professionals. How effective promotion can be designed and organized remains unclear, however. The present work addresses this question by investigating the implementation of a cardiologic telesurveillance system in 12 hospitals. Despite an identical technology and unproblematic installation, only in five cases full implementation was achieved. Four promotion strategies—focused on a different combination of three aspects (planning, team involvement, and hero innovation)—were identified through case studies. Qualitative comparative analysis was then employed to identify three alternative strategies for effective promotion.

Stratified cost-utility analysis of C-Leg versus mechanical knees: Findings from an Italian sample of transfemoral amputees

Background: The fitting rate of the C-Leg electronic knee (Otto-Bock, D) has increased steadily over the last 15 years. Current cost-utility studies, however, have not considered the patients’ characteristics. Objectives: To complete a cost-utility analysis involving C-Leg and mechanical knee users; “age at the time of enrollment,” “age at the time of first prosthesis,” and “experience with the current type of prosthesis” are assumed as non-nested stratification parameters. Study design: Cohort retrospective. Methods: In all, 70 C-Leg and 57 mechanical knee users were selected. For each stratification criteria, we evaluated the cost-utility of C-Leg versus mechanical knees by computing the incremental cost-utility ratio, that is, the ratio of the “difference in cost” and the “difference in utility” of the two technologies. Cost consisted of acquisition, maintenance, transportation, and lodging expenses. Utility was measured in terms of quality-adjusted life years, computed on the basis of participants’ answers to the EQ-5D questionnaire. Results: Patients over 40 years at the time of first prosthesis were the only group featuring an incremental cost-utility ratio (88,779 €/quality-adjusted life year) above the National Institute for Health and Care Excellence practical cost-utility threshold (54,120 €/quality-adjusted live year): C-Leg users experience a significant improvement of “mobility,” but limited outcomes on “usual activities,” “self-care,” “depression/anxiety,” and reduction of “pain/discomfort.” Conclusion: The stratified cost-utility results have relevant clinical implications and provide useful information for practitioners in tailoring interventions. Clinical relevance A cost-utility analysis that considered patients characteristics provided insights on the “affordability” of C-Leg compared to mechanical knees. In particular, results suggest that C-Leg has a significant impact on “mobility” for first-time prosthetic users over 40 years, but implementation of specific low-cost physical/psychosocial interventions is required to retun within cost-utility thresholds.