Luca Ianni

The rise of governmentality in the Italian National Health System: physiology or pathology of a decentralized and (ongoing) federalist system?

In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency of its health-care system while decentralizing at a regional level. In this perspective, we provide evidence backing up some of the assumptions made in previous works as well as new food-for thought – specifically on how governmentality and federalism should meet – to reshape the debate on decentralization in health care.

Accounting and the government of the agricultural economy: Arrigo Serpieri and the Reclamation Consortia

ABSTRACT Drawing on primary sources gathered from repositories in Abruzzo, Bologna and Rome, this study – underpinned by the framework of governmentality – analyses the accounting, financial and governmental practices deployed as a consequence of the Reclamation Consortia in Fascist Italy. In a scenario stimulated by the ascent of the Fascist discourse on the Agricultural Corporative Economy, this analysis seeks to show the new technologies of government deployed by the State and local communities through the Reclamation Consortia Reform. The study also unveils the leading role in the change process played by Arrigo Serpieri who, besides acting as Under Secretary of State at the Ministry of Agriculture in Mussolini’s government, was considered at the time Italy’s most important agricultural expert.

Institutional pressures, isomorphic changes and key agents in the transfer of knowledge of Lean in Healthcare

Purpose Application of operations management in healthcare is particularly promising to improve the overall organisational performance, although the Italian system is behind in introducing related techniques and methods. One of the recent experiments in healthcare is the implementation of “Lean Thinking”. The purpose of this paper is to investigate which exogenous forces are driving knowledge transfer on Lean, both in the private and public healthcare sectors. Design/methodology/approach Informed by institutional sociology (DiMaggio and Powell, 1983; Powell and DiMaggio, 1991), the paper builds on the case study methodology (Yin, 2013) to elucidate the environmental pressures that are encouraging the adoption of Lean thinking by Italian hospitals and Local Health Authorities. Findings The study highlights the economic, coercive, mimetic and normative pressures that are triggering the adoption of Lean thinking in the Italian National Health System (INHS). At the same time, the authors reveal the pivotal importance and innovative roles played by diverse prominent key-actors in the different organisations investigated. Originality/value Considering that little is known to date regarding which exogenous forces are driving the transfer of knowledge on Lean, especially in the public healthcare sector, the paper allows scholars to focus on patterns of isomorphic change and will facilitate managers and policy makers to understand exogenous factors stimulating the transfer of Lean thinking and the subsequent innovation within health organisations and systems.