The Community House as decentralized platform of a Hub hospital The case of oncology services delivered by the Health House of Bettola (AUSL, Piacenza, Italy)

Journal title MECOSAN
Author/s Michela Bibini, Giovanni Fattore, Francesco Longo, Francesca Meda
Publishing Year 2022 Issue 2022/121 Language Italian
Pages 21 P. 91-131 File size 0 KB
DOI 10.3280/mesa2022-121oa14323
DOI is like a bar code for intellectual property: to have more infomation click here

View article Download Open Access article

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

In the current context of the urgent and important investments for the development of community assistance, as envisaged by the Italian Recovery and Resilience Plan, this article has a twofold objective: (a) to describe a model of decentralization of the provision of specialized services normally managed at hub hospitals, capable of enhancing the Community Houses as a network of proximity delivery settings and (b) analyze the context determinants and managerial drivers that can be operated to design, implement and consolidate a transformational change service innovation.The article presents the case of a transformative innovation in a “Casa della Salute” (House of Health) in a mountain area of the Piacenza Health Authority. It describes how, following a gradual process of decentralization on oncologic services, the House of Health of Bettola, a municipality of 2,600 inhabitants, delivers weekly oncological treatments decided by the Oncologic Unit of the Piacenza Hospital but locally delivered by two oncology professionals (one doctor and one nurse). The success of this case relies on the convergence of management and clinical leadership, the gradualism of the entire decentralization of oncologist services in the Health Authority, the motivation of professionals and patients and a careful attention to logistic issues. This case may serve as a prototype for replications in other settings and for introducing similar innovations in other therapeutic areas.

Keywords: ; House of Health; oncology; decentralization; territory; change management; innovation redesign

  1. Ackerman Anderson L. (1986). Development, Transition or Transformation: The Question of Change in Organizations. In: Van Eynde D.F., Hoy J.C., Van Eynde D.C. (eds.) (1997). Organization Development Classics. San Francisco: Jossey Bass.
  2. Adams W.C. (2015). Conducting semi-structured interviews. Handbook of practical program evaluation, 4: 492-505.
  3. Ambroggi M., Biasini C., Del Giovane C. et al. (2015). Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist, 20: 1378-1385.
  4. Anderson D., Anderson L.A. (2002). Beyond change management: Advanced strategies for today’s transformational leaders. San Francisco: John Wiley & Sons.
  5. Anessi-Pessina E., Cicchetti A., Spandonaro F., Polistena B., D’Angela D., Masella C., ... Sottoriva C.B. (2021). Proposte per l’attuazione del PNRR in sanità: governance, riparto, fattori abilitanti e linee realizzative delle missioni. Mecosan, 119: 89-118.
  6. AUSL Piacenza (2017). Il Piano di organizzazione e sviluppo della Sanità di Piacenza Rete ospedaliera, rete territoriale e sviluppo aziendale della AUSL di Piacenza. -- http://www.ausl.pc.it/azienda/organizzazione_sviluppo/.
  7. Barley S. (1986). Technology as an occasion for structuring: Evidence from observations of CT scanners and the social order of radiology departments. Administrative Science Quarterly, 31(1): 78-108.
  8. Barley S.R. (1990). The alignment of technology and structure through roles and networks. Administrative Science Quarterly, 35(1): 61-103.
  9. Barriball K.L., While A. (1994). Collecting data using a semi-structured interview: a discussion paper. Journal of Advanced Nursing-Institutional Subscription, 19(2): 328-335.
  10. Bason C. (2010). Leading public sector innovation: Co-creating for a better society. Bristol: Policy Press.
  11. Baumbusch J. (2010). Semi-structured interviewing in practice-close research. Journal for Specialists in Pediatric Nursing, 15(3): 255-258.
  12. Becker H.S. (1971). Sociological work. Transaction publishers.
  13. Bertolini M., Bevilacqua M., Ciarapica F.E., Giacchetta G. (2011). Business process re‐engineering in healthcare management: a case study. Business Process Management Journal, 17(1): 42-66.
  14. Black L.J., Carlile P.R., Repenning N.P. (2004). A dynamic theory of expertise and occupational boundaries in new technology implementation: building on Barley’s study of CT scanning. Administrative Science Quarterly, 49(4): 572-607.
  15. Bobini M., Furnari A., Ricci A. (2020). Gli ospedali di piccole dimensioni del SSN: mappatura, profilo e prospettive nella rete ospedaliera nazionale. In: Cergas (a cura di). Rapporto OASI 2020. Milano: Egea.
  16. Boscolo P.R., Fenech L., Rappini V., Rotolo A. (2019). Tecnologia e innovazione nei modelli di servizio in sanità. In: Cergas Bocconi (a cura di). Rapporto OASI 2019. Milano: Egea.
  17. Bucciardini R., D’Angelo C., Sinisi L. (2020). “La sanità del territorio”. Salute e non solo Sanità. Come riorientare gli investimenti in sanità in un’ottica di sviluppo sostenibile. Roma: ASviS Alleanza italiana per lo sviluppo sostenibile, 13-16. -- https://asvis.it/public/asvis2/files/Approfondimenti/PositionPaperGdLGoal3.pdf (accesso 2021.07.20).
  18. Buchanan D., Addicott R., FitzGerald L., Ferlie E., Baeza J. (2007). Nobody in Charge: Distributed Change Leadership in Health Care. Human Relations, 60(7): 1065-1090.
  19. Camera dei Deputati, Servizio Studi Affari Sociali (2021). Case della salute ed Ospedali di comunità: i presidi delle cure intermedie. Mappatura sul territorio e normativa nazionale e regionale, n. 144, 1.3.2021. -- http://documenti.camera.it/leg18/dossier/testi/AS0207.htm?_1619198796640.
  20. Cavanna L., Citterio C. et al. (2021). Le cure oncologiche ed ematologiche sul territorio secondo il modello dell’ASL di Piacenza. Rendiconto di 4 anni consecutivi. Recenti Prog Med 2021, 112: 1-8.
  21. Compagni A., Mele V., Ravasi D. (2015). How early implementations influence later adoptions of innovation: social positioning and skill reproduction in the diffusion of robotic surgery. Academy of Management Journal, 58(1): 242-278.
  22. Damanpour F. (1991). Organisational Innovations: A Meta-Analysis of Effects of Determinants and Moderators. Academy of Management Journal, 34: 555-90.
  23. Damanpour F. (1992). Organizational Size and Innovation. Organization Studies, 13(3): 375-402.
  24. Damanpour F. (1996). Organizational Complexity and Innovation: Developing and Testing Multiple Contingency Models. Management Science, 42: 693-716.
  25. Dearnley C. (2005). A reflection on the use of semi-structured interviews. Nurse Researcher, 13(1): 19-28.
  26. Del Vecchio M., Lega F., Prenestini A. (2016). La trasformazione delle unità operative: team multidisciplinari ed équipe itineranti. Rapporto OASI 2016, Cergas Bocconi.
  27. Denis J.L., Hebert Y., Langley A., Lozeau D., Trottier L.H. (2002). Explaining diffusion patterns for complex health care innovations. Health Care Manage Rev., 27(3): 60-73.
  28. Eccles M.P., Mittman B.S. (2006). Welcome to implementation science. Implement. Sci., 1(1). DOI: 10.1186/1748-5908-1-1.
  29. Edmondson A., Bohmer R., Pisano G. (2001). Disrupted routines: Team learning and new technology Implementation in Hospitals. Administrative Science Quarterly, 46(4): 685-716.
  30. Ferlie E., Fitzgerald L., Wood M., Hawkins C. (2005). The non spread of innovations: The mediating role of professionals. Academy of Management Journal, 48(1): 117-134.
  31. Fidel R. (1984). The case study method: A case study. Library and Information Science Research, 6(3): 273-288.
  32. Giudice L., Mallarini E., Preti L.M., Rappini V. (2021). 13 Case della salute: evoluzione delle configurazioni tra fisico, digitale e ruolo nella rete. In: Rapporto OASI 2021. Milano: Egea.
  33. Greenhalgh T., Robert G., Macfarlane F., Bate P., Kyriakidou O. (2004). Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. Milbank Quarterly, 82(4): 581-629.
  34. Gummesson E. (1988). Qualitative methods in management research. Lund, Norway: Studentlitteratur, Chartwell-Bratt.
  35. Hartley J.F. (1994). Case studies in organizational research. In: Cassell C., Symon G. (edited by). Qualitative methods in organizational research: A practical guide, 209-29. London: Sage.
  36. Hendy J., Barlow J. (2012). The role of the organizational champion in achieving health system change. Social Science and Medicine, 74(3): 348-355.
  37. ISTAT (2022). Dati demografici per regione, provincia e comune. -- https://www.istat.it/it/popolazione-e-famiglie?dati.
  38. Junginger S. (2013). Design and innovation in the public sector: Matters of design in policy-making and policy implementation. Annual Review of Policy Design, 1(1): 1-11.
  39. Junginger S. (2015). Organizational design legacies and service design. The Design Journal, 18(2): 209-226.
  40. Kallio H., Pietilä A.M., Johnson M., Kangasniemi M. (2016). Systematic methodological review: developing a framework for a qualitative semistructured interview guide. Journal of advanced nursing, 72(12): 2954-2965.
  41. Klein K.J., Sorra J.S. (1996). The challenge of innovation implementation. Academy of management review, 21(4): 1055-1080.
  42. Lawrenz F., Keiser N., Lavoie B. (2003). Evaluative site visits: A methodological review. American journal of evaluation, 24(3): 341-352.
  43. Linnander E.L., Mantopoulos J.M., Allen N., Nembhard I.M., Bradley E.H. (2017). Professionalizing healthcare management: a descriptive case study. Int J Health Policy Manag., 6(10): 555-560.
  44. Lukas C.V., Holmes S.K., Cohen A.B., Restuccia J., Cramer I.E., Shwartz M., Charns M.P. (2007). Transformational change in health care systems: an organizational model. Health care management review, 32(4): 309-320.
  45. Malmberg L., Rodrigues V., Lännerström L., Wetter-Edman K., Vink J., Holmlid S. (2019). Service Design as a Transformational Driver Toward Person- Centered Care in Healthcare. In: Pfannstiel M., Rasche C. (eds). Service Design and Service Thinking in Healthcare and Hospital Management. Springer, Cham. DOI: 10.1007/978-3-030-00749-2_1.
  46. Ministero dell’Economia e delle Finanze (2021). Missione 6: Salute- Reti di prossimità, strutture e telemedicina per l’assistenza sanitaria territoriale. Piano Nazionale di Ripresa e Resilienza 2021: 224-227. -- www.governo.it/sites/governo.it/files/PNRR.pdf.
  47. Mordenti P., Proietto M., Citterio C. et al. (2018). La cura oncologica nel territorio. Esperienza nella casa della salute: risultati preliminari nella provincia di Piacenza. Recenti Prog Med., 109: 337-341.
  48. Mulgan G. (2014). Design in public and social innovation: what works and what could work better. Nesta (Ed.). Accessed January 15, 2018, -- from https://www.nesta.org.uk/sites/default/ files/design_what_works_what_could_work_better.pdf.
  49. Neodemos (2021). La situazione demografica dell’Emilia Romagna e le proiezioni al 2050. Rapporto di Ricerca. Associazione Neodemos.
  50. Odone A., Saccani E., Chiesa V., Brambilla A., Brianti E., Fabi M., ... Signorelli C. (2016). The implementation of a Community Health Centre-based primary care model in Italy. The experience of the Case della Salute in the Emilia-Romagna Region. Annali dell’Istituto Superiore di Sanità, 52(1): 70-77.
  51. Orlikowski W.J. (2000). Using Technology and Constituting Structures: A Practice Lens for Studying Technology in Organizations. Organization Science, 11(4): 404-428.
  52. Perrone F., Di Maio M., Efficace F. et al. (2019). Assessing financial toxicity in patients with cancer: moving away from a one-size-fits-all approach. J Oncol Pract, 15: 460-461.
  53. Pfannstiel M.A., Rasche C. (2019). Service Design and Service Thinking in Healthcare and Hospital Management. Berlin: Springer International Publishing.
  54. Provincia di Piacenza, Ufficio di Statistica (2021). La popolazione piacentina secondo i dati del nuovo censimento permanente riferiti all’anno 2019: evidenze dal confronto con gli altri territori e dall’analisi a livello comunale.
  55. Regione Emilia-Romagna (2010). Decreto Giunta Regionale 291, Casa della Salute: indicazioni regionali per la realizzazione e l’organizzazione funzionale. -- https://salute.regione.emilia-romagna.it/cure-primarie/case-della-salute/documentazione-case-della-salute/delibere.
  56. Regione Emilia-Romagna (2016). Decreto Giunta Regionale 2128, Case della Salute: indicazioni regionali per il coordinamento e lo sviluppo delle comunità di professionisti e della medicina d’iniziativa. -- https://salute.regione.emilia-romagna.it/cureprimarie/casedellasalute/documentazionecasedellasalute/delibere.
  57. Regione Emilia-Romagna (2018). Le Case della Salute in Emilia-Romagna. -- http://salute.regione.emiliaromagna.it/cure-primarie/case-della-salute.
  58. Robert G., Greenhalgh T., MacFarlane F., Peacock R. (2010). Adopting and assimilating new non-pharmaceutical technologies into health care: a systematic review. J Health Serv Res Policy, 2010 Oct; 15(4): 243-50. DOI: 10.1258/jhsrp.2010.009137. Epub 2010 Jun 30. PMID: 20592046.
  59. Rogers E.M. (1995). The Diffusion of Innovations, 4th edn. New York: Free Press.
  60. Rogers E.M. (2004). A Prospective and Retrospective Look at the Diffusion Model. Journal of Health Communication, 9(9): 13-19.
  61. Sangiorgi D. (2011). Transformative services and transformation design. International Journal of Design, 5(2): 29-40.
  62. Sligo J., Roberts V., Gauld R., Villa L., Thirlwall S. (2019). A checklist for healthcare organisations undergoing transformational change associated with large-scale health information systems implementation. Health Policy and Technology, 8(3): 237-247.
  63. Smith J. (2001). Redesigning health care: radical redesign is a way to radically improve. BMJ, 322: 1257-1258.
  64. Svengren L. (1993). Case study methods in design management research. Design studies, 14(4): 444-456.
  65. Sykes W. (1990). Validity and reliability in qualitative market research: A review of the literature. Journal of the Market Research Society, 32(3): 289-328.
  66. Tralongo P., Gebbia V., Mercadante S. et al. (2021). Cancer: new needs, new models. Is it time for a community oncologist? Another brick in the wall. Cancer, 13: 1919.
  67. Ugolini M. (2021). Da Case della Salute a Case della Comunità: condizioni di fragilità e occasioni di rigenerazione urbana, Territorio, 97 (2, supplemento): 147-153.
  68. Valentine M.A., Edmondson A.C. (2015). Team Scaffolds: How Mesolevel Structures Enable Role-Based Coordination in Temporary Groups. Organization Science, 26(2): 405-422.
  69. Van de Ven A.H., Polley D.E., Garud R., Venkataraman S. (1999). The Innovation Journey. Oxford: Oxford University Press.
  70. Whiting L.S. (2008). Semi-structured interviews: guidance for novice researchers. Nursing Standard, 22(23), 35-40.
  71. Yin R.K. (1989). Case study research: Design and methods. Applied Social Research Series, Vol. 5. London: Sage.
  72. Yin R.K. (2009). Case study research: Design and methods (Vol. 5). London: Sage.
  73. Yu E., Sangiorgi D. (2017). Service design as an approach to implement the value cocreation perspective in new service development. Journal of Service Research, 21(1): 40-58.
  74. Yu E., Sangiorgi D. (2018). Service design as an approach to implement the value cocreation perspective in new service development. Journal of Service Research, 21(1): 40-58.
  75. Zahra A.S., George G. (2002). Absorptive Capacity: A Review, Reconceptualization and Extension. Academy of Management Review, 27(2): 185-203.

  • Reducing the burden of travel and environmental impact through decentralization of cancer care Giovanni Fattore, Michela Bobini, Francesca Meda, Benedetta Pongiglione, Luca Baldino, Stefano Gandolfi, Licia Confalonieri, Manuela Proietto, Stefano Vecchia, Luigi Cavanna, in Health Services Management Research 09514848241229564/2024
    DOI: 10.1177/09514848241229564
  • La governance collaborativa: un'opportunità per gestire le cure oncologiche in rete Francesca Meda, Michela Bobini, Giovanni Fattore, in MECOSAN 126/2024 pp.95
    DOI: 10.3280/mesa2023-126oa17288

Michela Bibini, Giovanni Fattore, Francesco Longo, Francesca Meda, La Casa della Comunità come piattaforma erogativa decentrata dell’ospedale Hub Il caso servizi oncologici della Casa della Salute di Bettola (A in "MECOSAN" 121/2022, pp 91-131, DOI: 10.3280/mesa2022-121oa14323