Verdiana Morando

Managing cancer care through service delivery networks: The role of professional collaboration in two European cancer networks

Background The study examines two meso-strategic cancer networks, exploring to what extent collaboration can strengthen or hamper network effectiveness. Unlike macro-strategic networks, meso-strategic networks have no hierarchical governance structures nor are they institutionalised within healthcare services’ delivery systems. This study aims to analyse the models of professional cooperation and the tools developed for managing clinical practice within two meso-strategic, European cancer networks. Methods Multiple case study design based on the comparative analysis of two cancer networks: Iridium, in Antwerp, Belgium and the Institut Català d’Oncologia in Catalonia, Spain. The case studies applied mixed methods, with qualitative research based on semi-structured interviews (n = 35) together with case-site observation and material collection. Results The analysis identified four levels of collaborative intensity within medical specialties as well as in multidisciplinary settings, which became both platforms for crosscutting clinical work between hubs’ experts and local care teams and the levers for network-based tools development. The organisation of clinical practice relied on professional-based cooperative processes and tiers, lacking vertical integration mechanisms. Conclusions The intensity of professional linkages largely shaped the potential of meso-strategic cancer networks to influence clinical practice organisation. Conversely, the introduction of managerial techniques or network governance structures, without introducing vertical hierarchies, was found to be critical solutions.

The strategy role of transitional care units to support Integrated Care and Personalised pathways for frail persons

The paper presents a comparative analysis of three models of transitional care units that have been set up in Italy in the last three years within the processes of Regional Healthcare Services and healthcare organisations’ reforms. The comparative analysis is worth of providing interesting insights and generalizable lessons learnt from integrated care in practice. The three cases of transitional care units belong to a similar background wherein greater needs for care coordination across the supply chain have risen, but the implementation has brought to different organizational solutions to meet the contextual features. The common base-line scenario can be described by four fundamentals: 1) the merge and establishment of larger Local Health Authorities, serving a population of 1.2mln inhabitants on average; 2) the set-up of integrated care models between hospital care and primary care (as intermediate care, rehab., residential care, palliative care, home care or hospital at home); 3) the use of clinical governance tools and methods (as Integrated care pathways (ICPs), clinical networks), exploiting approaches deriving from the population health management (PHM); 4) the efforts to strengthen the integration between health and social care, foremost by using tools and targeted case management models for the most fragile persons. From this scenario, three different models of transitional care units rose, in Veneto Region, in Tuscany and in Lombardy, to build up integrated care by streamline ICPs across the supply chain of services and professionals within the newly established LHAs. The paper discusses comparatively the three cases of transitional care units. It analyses in depth three cases, one from each Region, based on different healthcare organization unit. The case study analysis allows to tackle out the organizational, professional and operational tools applied distinctively, based on the data collection of their initial activities and interviews with the key players. From the comparisons, lesson learnt can be drawn for generalization, detangling the contextual organizational features and service design’s needs (the path and resources dependency of each model) from more general observations and tips that could foster the sustainability and efficacy of similar services.