Rocco Palumbo

Contextualizing co-production of health care: a systematic literature review

Purpose – The purpose of this paper is to contextualize the concepts of “service co-production” and “value co-creation” to health care services, challenging the traditional bio-medical model which focusses on illness treatment and neglects the role played by patients in the provision of care. Design/methodology/approach – For this purpose, the author conducted a systematic review, which paved the way for the identification of the concept of “health care co-production” and allowed to discuss its effects and implications. Starting from a database of 254 records, 65 papers have been included in systematic review and informed the development of this paper. Findings – Co-production of health care services implies the establishment of co-creating partnerships between health care professionals and patients, which are aimed at mobilizing the dormant resources of the latter. However, several barriers prevent the full implementation of health care co-production, nurturing the application of the traditional bio-medi...

The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy

Inadequate health literacy, namely the problematic individuals ability to navigate the health care system, has been depicted as a silent epidemic affecting a large part of the world population. Inadequate health literacy has been variously found to be a predictor of patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. However, to date the evidence on the prevalence of limited health literacy is heterogeneous; moreover, studies dealing with this topic show a pronounced geographical concentration. To contribute in filling these gaps, this paper investigates health literacy skills in Italy. Drawing on the European Health Literacy Survey (HLS-EU), a tool to measure self-perceived levels of health literacy was administered to a representative sample of Italian citizens. A stepwise regression analysis allowed to shed light on the determinants and consequences of limited health literacy. Findings suggested that inadequate health literacy is a prevailing problem in Italy, even though it has been overlooked by both policy makers and health care practitioners. Financial deprivation was found to be a significant predictor of inadequate health literacy. Low health literate patients reported higher hospitalization rates and greater use of health services. As compared with the European Countries, Italy showed some peculiarities in terms of health literacy levels and socio-demographic determinants of health literacy, which provide with intriguing insights for policy making.

Designing health-literate health care organization: A literature review:

Health literacy is usually described as a silent epidemic, which is challenging the sustainability of health care systems all over the world. The scientific literature has discussed the drawbacks of marginal health literacy on the functioning of the health care organizations. In particular, limited health literacy has been associated with: poorer ability of patients to comprehend health information, deficient medication adherence, insufficient use of prevention services, higher hospitalization rates, and greater health service utilization. In most of the cases, health literacy has been understood as an individual trait, which ultimately concerns the patients’ ability to obtain, process, and understand health information to navigate the health system. Alternatively, poor attention has been paid to the health literacy of the organizations operating within the health system, that is to say “organizational health literacy”. Indeed, neither the scholars nor the practitioners have adequately addressed the role played by the health care organizations to meet the needs of patients who live with limited health literacy. To contribute in filling such a gap, this study discusses the design and the structure of health-literate health care organizations. For this purpose, a systematic literature review was performed, involving 69 articles indexed in Scopus-Elsevier, Pub-Med, and Google Scholar to point out how the health care organizations face health literacy issues and to discuss what tools are used by the health care organizations to meet the information needs of people living with limited health literacy. Health-literate health care organizations turn out to be crucial to enhance patient engagement and improve health outcomes.

Contextualizing Health Literacy to Health Care Organizations: Exploratory Insights

Parker, Ratzen and Lurie (2003) pointed out that a silent epidemic is affecting the health status of the American population, namely poor health literacy. Actually, inadequate health literacy is the main cause of the patients’ inability to navigate the health care environment, paving the way for inappropriateness in the provision of care as well as for poor health outcomes. Moreover, it has been esteemed that a third of the European population is not able to properly understand, process and use health information (HLS-EU Consortium, 2012). The same issue has been identified in several Asian countries (see, for example, Nakayama et al., 2015; Pednekar, Gupta & Gupta, 2011). What is striking is that—until today—the attention has been focused on the individual determinants of low health literacy, while studies concerning the organizational health literacy—that is to say, the ability of health care organization to establish friendly and comfortable relationships with the patients—are uncommon (Weaver, Wray, Zellin, Gautam & Jupka, 2012). This article is aimed at exploring the way health care organizations deal with patients living with inadequate health literacy. Drawing on the prevailing literature (Brach et al., 2012; DeWalt et al., 2013; Matthews & Sewell, 2002; Murphy-Knoll, 2007; Stableford & Mettger, 2007) the main approaches to improve organizational health literacy are examined. Then, a distinction between formal and informal tools to address organizational health literacy is suggested and the effectiveness of both of them is compared. The findings of the research suggest that informal tools are more common than formal tools, even though the former have lower perceived effectiveness as compared with the latter. Health care organizations seem to be still far from effectively activating comprehensive organizational health literacy pathways. There is a desperate need for systemic efforts to enhance the awareness of organizational health literacy and to encourage processes of change towards health literate organizational environments.

Dream or reality? A recipe for sustainable and innovative health care ecosystems

Purpose Service ecosystems are gaining credence among management scholars. However, there is still little agreement about the distinguishing attributes of service ecosystems in both the public and the private sectors. The purpose of this paper is to focus on the health care service system, suggesting a “recipe” for the implementation of a sustainable and innovative health care service ecosystem. Design/methodology/approach A mixed methodology was used. First, a critical literature review was conducted to lay the conceptual foundations of this study. Then a theory about the institutional, organizational and managerial requisites for the implementation of a health care service ecosystem was developed. Findings The health care sector is appropriate for the core tenets of the service ecosystem perspective. Tailored interventions aimed at improving the functioning of the health care service ecosystem should be implemented at the micro, meso, macro and mega levels. Patient empowerment, patient-centered care and integrated care are the fundamental ingredients of the recipe for effective health care service ecosystems. Practical implications The ecosystem approach provides health policy makers with interesting insights to help shape the health care service system of the future. The paper also contributes to the innovation of managerial practices emphasizing the role of patient involvement in the design and delivery of health care. Originality/value This is one of the first attempts to systematize scientific knowledge about service ecosystems in the health care sector. An agenda for further research is suggested, in order to further advance the establishment of an effective and innovative health care service ecosystem.

Challenging Servant Leadership In The Nonprofit Sector: The Side Effects Of Servant Leadership

Leadership is a critical success factor for nonprofit organizations. However, scholars and practitioners are consistent in claiming that the nonprofit sector is confronting a situation of leadership deficit. The aim of this study is to provide exploratory insights about a style of leadership that seems to be especially fitting to the nonprofit sector, but that is still poorly discussed in the scientific and professional literature: servant leadership. The servant leader is inspired by the intention of serving other members of the organization, with the eventual purpose of making them wiser, more autonomous, and more likely to become servants. Drawing from the findings of a participant observation that I performed within a charitable organization operating in Tanzania (East Africa), in this study, I discuss counterintuitive findings about the effects of servant leadership on the behaviors of the followers. In several circumstances, servant leadership is likely to constrain rather than to empower followers, discouraging their organizational commitment. In fact, followers could become reliant on the figure of the servant leader, thus being unwilling to adopt a proactive behavior to meet the organizational instances. Based on these findings, I suggest an agenda for further research. As well, I point out conceptual and empirical insights.

Health Outcomes and Patient Empowerment The Case of Health Budgets in Italy

Scholars claim that the outcomes of health interventions are the products of three factors: the size, the penetration and the sustainability of their effects. Nonetheless, the prevailing biomedical ethic of care engenders a mere ‘fix-it’ approach, which focuses on the clinical treatment of the disease and neglects the role of patients in the process of care. This approach undermines both the size and the penetration of health interventions. From this standpoint, the authors examine different health interventions aimed at improving the size and the penetration of their effects through the empowerment of the patients and their involvement in the provision of care. They are confronted in terms of two different criteria: the ‘intensity’ of the health care co-production and the ‘breadth’ of the health-related needs contemplated. Besides, their outcomes—in terms of health status improvement, patients’ satisfaction and cost savings—have been contrasted. A detailed case study dealing with a pilot project launched in Italy, which involved full-fledged empowerment of the patient, is presented. It is compared with similar initiatives carried out in other European and non-European countries, with the purpose of stressing the peculiarities of the former and explaining the reasons for its success. The findings of this study support the exploratory hypothesis that the higher the intensity of co-production and the wider the breadth of health-related needs considered, the better the outcomes of health interventions.

Empowering organizations to empower patients: An organizational health literacy approach

Abstract Background: Health literacy has been usually discussed as an individual trait, concerning the patient ability to navigate the health care service system. Alternatively, the organizational side of health literacy, or the ability of health care organizations to establish comfortable relationships with patients, has been widely overlooked. This manuscript is one of the first attempts to empirically examine organizational health literacy as a key attribute of health care organizations. Method: A convenience sample of municipal pharmacies operating within the Italian National Health Services was built. Their awareness of organizational health literacy issues and their ability to establish a co-creating relationship with their users were assessed through the Italian version of the Health Literacy Assessment Tool. Three domains were included in the assessment tool: (1) the accessibility of print informative materials used in the pharmacy; (2) the interpersonal communication between the pharmacy staff and the patients; and (3) the sensitivity of the pharmacy staff to health literacy issues. Results: The units of analysis were aware of the impacts of inadequate organizational health literacy on the ability of patients to understand and use health information; however, the organizational commitment to address the needs and the expectations of low health literate patients was limited among the units of analysis. Conclusions: Organizational health literacy is a crucial, but neglected issue among health care practitioners. There is a desperate need for an improvement of health care organizations’ friendliness, which is an essential ingredient in the recipe for patient empowerment.

Improving health care quality: the implementation of whistleblowing

In line with the current literature, the purpose of this paper is to contribute to a better understanding of whistleblowing procedures and their influence on overall organisational quality. To this end, institutional, organisational, and cultural barriers to whistleblowing implementation have been investigated.,A qualitative analysis based on three explorative case studies investigates and compares different whistleblowing practices implemented in health care organisations, operating within the Italian National Health Service (INHS).,INHS organisations have implemented whistleblowing procedures in different ways, despite the fact that the procedures are laid down by law. These differences are mainly due to cultural, administrative, organisational, and process barriers, which have a deep impact on whistleblowing integration in managerial practices and their influence on the overall quality of health processes and services.,This research paper was limited by the analysis of three Italian public health care organisations, which did not allow the generalisability of findings. Therefore, the study offers interesting insights on the way effective whistleblowing systems should be implemented in order to support managers to improve organisation’s management and service quality.,The paper represents one of the first attempts to structurally analyse the practice of whistleblowing in an Italian healthcare system. Therefore the study has mainly focussed not only on the analysis of whistleblowing practices, but also on their impacts on the improvement of organisational processes’ quality and, subsequently, on social well-being.

Reforming penitentiary health. The transition from ‘cure’ to ‘care’ in Italian prisons

Abstract Background Until today, inadequate attention has been paid to the distinguishing attributes of healthcare provision in penal institution. Healthcare has been conceived either as ancillary or as a core component of imprisonment. While the former idea prevailed in the past, leading to a bio-medical approach to care in prisons, the latter is currently arising. Method This paper discusses the change in the approach to care in Italian penal institutions, examining their inertia. The design of the research consisted of a mixed approach: at the beginning, a desk study of law documents has been realized; then, a semi-structured 48-item questionnaire has been addressed to the health managers operating in the penal institutions of a southern Italian region. Results This study suggests that penitentiary health areas are prone to change and they are willing to establish inter-organizational relationships with healthcare organizations operating within the National Health Service. Notwithstanding, they have to cope with the institutional inertia of penal institutions, that favour organizational monism. The legislative efforts are not sufficient to foster a process of change in prisons; healthcare professionals usually act as catalysts of change, championing it and encouraging the reorganization of penitentiary healthcare. Conclusions This study paves the way for both further theoretical developments and practical implications. On the one hand, it suggests a reconceptualization of healthcare provision within penal institutions, claiming the belonging of penitentiary health to public health. On the other hand, penal institutions are unwilling to change, due to their nature of total institutions: the involvement of healthcare professional in fostering the reorganization of healthcare provision is thus crucial to legitimate the process of change.