Rebecca Levy Orelli

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.

Integrated Reporting and Integrated Thinking in Italian Public Sector Organisations

This paper aims to explore the linkages between integrated reporting (IR) and organisations’ internal processes, specifically focusing on investigating the internal mechanisms of change that can lead organisations to adopt IR disclosure and how this impacts on integrated thinking internally.,The paper draws upon previous analysis and insights provided in the IR academic literature, as well as analysing several directives, policy and framework pronouncements. The study also draws on the management accounting change literature, using it as a lens to observe early adopters’ practice. In addition, it provides detailed case studies considering the internal processes of change in five early adopters of the integrated reporting framework ( ) and whether the adoption leads to internal “integrated thinking”. Five Italian public sector organisations are analysed, and the authors make use of official documents, press releases and in-depth semi-structured interviews with the major internal actors.,The research highlights that the processes of change in organisations adopting IR is their adoption of a way of thinking, that is, integrated thinking, as a result of the process of internalisation.,Given the short history of IR, this sample is small due to the small number of early adopters.,The paper provides academics and policymakers with insights into the process of change to be considered while adopting the and responds to calls in the IR literature for further field-based studies on IR’s impact on internal processes. Also, the paper highlights that the European Directive on the disclosure of non-financial and diversity information (2014/95/EU) has the potential to increase environmental, social and governance disclosures amongst European companies.

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.

Credit and accounting in early modern Italy: the case of the Monte di Pietà in Bologna

The foundation of Monti di Pietà by Franciscan friars in the fifteenth century represented a response to the problems of usury and difficult access to consumer credit. Some historians have highlighted the bank-like nature of the Monti, while others have considered them as economic institutions. This paper explores the case of the Monte di Pietà in Bologna during the early modern era, with particular reference to its governance model and its accounting and internal control practices. The presence of a well-preserved archive made it possible to perform a depth investigation of the emergence of accounting as a tool of control of the Monte.

The Evaluation of Networks Performance in Cultural Heritage Through Intelligent Systems

The paper analyses and discusses the application of intelligent systems in cultural networks by proposing a framework of performance evaluation based on the network approach. This approach is the natural evolution of cultural institutions that starts from the ownership and preservation of cultural heritage, to the use of web tools and to the perspective that considers the real user’s need identified not as simple information but as process to acquire a cultural awareness as the basis for cultural fruition. The research examined the search software based on the intelligent ones such as the Inquiry-Answer Extraction Networked System for Sustainable Tourism (IAST) to evaluate the performances. Thus, the basic research question is: which are the characteristics in the application of intelligent systems for cultural heritage networks which suggest a specific performance evaluation framework? On the basis of the undertaken analysis, different search tools existing in WEB could be applied to different profiles of users underlining the trade off between organizational top-down and bottom-up approaches.

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.