Aprire la black box dell’innovazione organizzativa: l’Intensità di Cura in pratica

Titolo Rivista MECOSAN
Autori/Curatori Elisa Giulia Liberati
Anno di pubblicazione 2016 Fascicolo 2015/95
Lingua Italiano Numero pagine 25 P. 55-79 Dimensione file 20190 KB
DOI 10.3280/MESA2015-095004
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FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

Innovare verso un modello per Intensita delle Cure (IdC) offre agli ospedali importanti potenzialita di miglioramento, tanto a livello di erogazione delle cure quanto sul piano organizzativo e gestionale. L’introduzione del modello IdC implica, peraltro, sostanziali modifiche nella struttura organizzativa e professionale dell’ospedale tradizionale nonche nelle sue precedenti modalita di funzionamento, finora poco esplorate dalla letteratura. Il presente studio analizza i processi di cambiamento sociale che sottendono e danno forma all’innovazione IdC. Fondato sui risultati di un’indagine etnografica, lo studio mostra che l’innovazione non consiste in un mero processo di adattamento, ma piuttosto in una complessa interazione tra il nuovo modello organizzativo e la struttura sociale preesistente dell’ospedale (per esempio gerarchie, norme comportamentali, gerghi in uso, regole implicite per la regolazione di autonomia e potere). Tale interazione genera sia esiti desiderati, sia effetti inattesi, che richiedono governo e attenta considerazione. Cosi ad esempio la creazione di nuovi team e setting di cura puo portare alla rinegoziazione degli accordi impliciti riguardo all’autonomia degli infermieri, interpretata in modo differente da professionisti di diverse specialita. Il contributo approfondisce questi processi e propone riflessioni e linee d’azione per decisori e manager, al fine di colmare il divario tra i programmi formali e le pratiche di cura quotidiane, capitalizzando cosi le potenzialita dell’innovazione.;

Keywords:Innovazione, ospedale, intensita di Cura, etnografia, pratiche, sistema sociale

  1. Abbott A. (1988). The System of Professions: An Essay on the Division of Expert Labor. Chicago: University Of Chicago Press.
  2. Allen D. (2009). From boundary concept to boundary object: the practice and politics of care pathway development. Social Science & Medicine, 69 (3): 354-361. DOI: 10.1016/j.socscimed.2009.05.002
  3. Bridges J., Fitzgerald L., Meyer J. (2007). New workforce roles in health care: Exploring the longer-term journey of organisational innovations. Journal of health organization and management, 21 (4/5): 381-392. DOI: 10.1108/1477726071077891
  4. Brown J.S., Duguid P. (1998). Organizing knowledge. California management review, 40 (3): 90-111. DOI: 10.2307/41165945
  5. Carbone C., Cosmi L., Lega F., Salvatore D. (2006). Ricognizione sullo stato dell’arte e sulle tendenze della normativa regionale in materia di organizzazione delle aziende sanitarie. Organizzazione sanitaria, 1: 25-32.
  6. Chantler C. (1989). Be a manager. British Medical Journal, 298(6686): 1505-8. DOI: 10.1136/bmj.298.6686.1505
  7. Charmaz K. (2006). Constructing grounded theory. London: Sage.
  8. Currie G., Finn R., Martin G. (2010). Role Transition and the Interaction of Relational and Social Identity: New Nursing Roles in the English NHS. Organization Studies, 31 (7): 941-961. DOI: 10.1177/0170840610373199
  9. Cunliffe A.L. (2001). Managers as practical authors: Reconstructing our understanding of management practice. Journal of Management Studies, 38 (3): 351-371. DOI: 10.1111/1467-6486.00240
  10. Cunliffe A.L. (2014). A very short, fairly interesting and reasonably cheap book about management. London: Sage.
  11. Czarniawska B. (2007). Shadowing: and other techniques for doing fieldwork in modern societies. Copenhagen: Copenhagen Business School Press.
  12. Degeling P., Maxwell S., Kennedy J., Coyle B. (2003). Medicine, management, and modernisation: a “danse macabre”? British Medical Journal, 326 (7390): 649-652. DOI: 10.1136/bmj.326.7390.64
  13. Dixon Woods M., Bosk C.L., Aveling E.L., Goeschel C.A., Pronovost P.J. (2011). Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Quarterly, 89 (2): 167-205. DOI: 10.1111/j.1468-0009.2011.00625.x
  14. Drotz E., Poksinska B. (2014). Lean in Healthcare from Employees’ Perspectives. Journal of Health Organization and Management, 28 (2): 177-195. DOI: 10.1108/jhom-03-2013-0066
  15. Eccles M.P., Armstrong D., Baker R., Cleary K., Davies H., Davies S., Sibbald B. (2009). An implementation research agenda. Implement Science, 4(1): 18. DOI: 10.1186/1748-5908-4-18
  16. Ferlie E., Fitzgerald L., Wood M., Hawkins C. (2013). The Nonspread of Innovations : The Mediating Role of Professionals. Academy of Management Journal, 48 (1): 117-134. DOI: 10.5465/AMJ.2005.15993150
  17. Fitzgerald L., Dopson S. (2005). Professional boundaries and the diffusion of innovation. In: Dopson S., Fitzgerald L. (a cura di). Knowledge to Action? Evidence-based Health Care in Context. Oxford: Oxford University Press.
  18. Flanagan J.C. (1954). The critical incident technique. Psychological bulletin, 51 (4): 327-358. DOI: 10.1037/h0061470
  19. Fournier V. (2000). Boundary work and the (un) making of professions. In: Malin N. (a cura di). Professionalism, boundaries and the workplace. London: Routledge.
  20. Gherardi S. (2000). Practice-based Theorizing on Learning and Knowing in Organizations. Organization, 7 (2): 211-223. DOI: 10.1177/135050840072001
  21. Gherardi S. (2006). Organizational knowledge: The texture of organizing. London: Blackwells.
  22. Gherardi S. (2012) How to conduct a practice-based study: Problems and methods. Cheltenham, UK: Edward Elgar Publishing.
  23. Gremler D.D. (2004). The critical incident technique in service research. Journal of service research, 7 (1): 65-89. DOI: 10.1177/1094670504266138
  24. Guba E.G., Lincoln Y.S. (1989). Fourth Generation Evaluation. Newbury Park, CA: Sage.
  25. Hammersley M. (2013). The myth of research-based policy and practice. London: Sage.
  26. Hogan H., Basnett I., McKee M. (2007). Consultants’ attitudes to clinical governance: barriers and incentives to engagement. Public Health, 121 (8): 614-622. DOI: 10.1016/j.puhe.2006.12.013
  27. King L., Appleton J.V. (1999). Fourth generation evaluation of health services: Exploring a methodology that offers equal voice to consumer and professional stakeholders. Qualitative Health Research, 9 (5): 698-710. DOI: 10.1177/104973299129122072
  28. Kitchener M. (2000). The “Bureaucratization” of professional roles: the case of clinical directors in UK hospitals. Organization, 7 (1): 129-154. DOI: 10.1177/135050840071007
  29. Koch T. (2000). “Having a say”: negotiation in fourth‐generation evaluation. Journal of Advanced Nursing, 31 (1): 117-125. DOI: 10.1046/j.1365-2648.2000.01253.x
  30. Lave J., Wenger E. (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press.
  31. Lay M., Papadopoulos I. (2007). An exploration of fourth generation evaluation in practice. Evaluation, 13 (4): 495-504. DOI: 10.1177/135638900708213
  32. Lega F., DePietro C. (2005). Converging patterns in hospital organization: beyond the professional bureaucracy. Health Policy, 74 (3): 261-281. DOI: 10.1016/j.healthpol.2005.01.010
  33. Lega F., Mauri M., Prenestini A. (2010). L’ospedale tra presente e futuro. Milano: Egea. Levy A. (2002). Organisation. In Barus-Michel J., Enriquez E., Levy, A. (Ed.) Vocabulaire de Psychosociologie. Paris: Eres.
  34. Liberati E.G., Moja L. (2014). L’ospedale centrato sul paziente e ancora lontano. Ricerca e Pratica, 30: 4-11.
  35. Mays N., Pope C. (2000). Assessing quality in qualitative research. British Medical Journal, 320 (7226): 50-52. DOI: 10.1136/bmj.320.7226.50.
  36. Martin G. P. , Currie G., Finn R. (2009). Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the modernization of the medical work force. Social Science and Medicine, 68(7):1191-1198. DOI: 10.1016/j.socscimed.2009.01.006
  37. McDonald R., Harrison S., Checkland K. (2008). Identity, contract and enterprise in a primary care setting: an English general practice case study. Organization, 15 (3): 355-370. DOI: 10.1177/1350508408088534
  38. McKee M., Healy J. (2002). Hospital in a changing Europe. Buckingham: Open University Press.
  39. Minnick A.F., Mion L.C., Johnson M.E., Catrambone C. (2007). How Unit Level Nursing Responsibilities are Structured in US Hospitals. Journal of Nursing Administration, 37 (10): 452-458. DOI: 10.1097/01.nna.0000285147.87612.96
  40. Mohrman S.A., Shani A.B. (Eds.) (2012). Organizing for sustainable healthcare. Organizing for Sustainable Series, Vol. 2. Bingley, UK: Emerald Publishing. Moja L., Liberati E.G., Galuppo L., Gorli M., Maraldi M., Nanni O., Rigon G., Ruggieri P., Ruggiero F., Scaratti G., Vaona A., Kwag K.H. (2014). Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study. Implemenation Science, 9: 105. DOI: 10.1186/s13012-014-0105-0
  41. Nicolini D. (2012) Practice Theory, Work and Organization. An Introduction. Oxford, UK: Oxford University Press.
  42. Orlikowski W.J. (2000). Using Technology and Constituting Structures: A Practice Lens for Studying Technology in Organizations. Organization Science, 11 (4): 404-428. DOI: 10.1287/orsc.11.4.404.14600
  43. Ovretveit J. (2011). Understanding the conditions for improvement: research to discover which context influences affect improvement success. BMJ quality and safety, 20 (1): i18-i23. DOI: 10.1136/bmjqs.2010.045955
  44. Powell A.E., Davies H.T.O. (2012). The struggle to improve patient care in the face of professional boundaries. Social Science and Medicine, 75(5): 807-14. DOI: 10.1016/j.socscimed.2012.03.049
  45. Ryan G.W., Bernard H.R. (2003). Techniques to identify themes. Field methods, 15 (1): 85-119.
  46. Sackett D.L., Rosenberg W., Gray J.A., Haynes R.B., Richardson W.S. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312 (7023): 71-72. DOI: 10.1136/bmj.312.7023.71
  47. Scaratti G., Gorli M., Ripamonti S. (2009). The power of professionally situated practice analysis in redesigning organisations: A psycho-sociological approach. Journal of Workplace Learning, 21(7): 538-554. DOI: 10.1108/13665620910985531
  48. Sorensen R., Paull G., Magann L., Davis J. (2013). Managing between the agendas: implementing health care reform policy in an acute care hospital. Journal of Health Organization and Management, 27 (6): 698-713. DOI: 10.1108/jhom-11-2011-0119
  49. Stake R. (1967). The countenance of educational evaluation. Teacher College Record, 68: 523-540. Stame N. (2004). Theory-based evaluation and types of complexity. Evaluation, 10(1): 58-76. DOI: 10.1177/1356389004043135
  50. Timmermans S., Berg M. (2003). The practice of medical technology. Sociology of health and illness, 25(3): 97-114. DOI: 10.1111/1467-9566.00342
  51. Timmons S., Coffey F., Vezyridis P. (2014). Implementing lean methods in the Emergency Department: the role of professions and professional status. Journal of Health Organization and Management, 28 (2): 214-228. DOI: 10.1108/jhom-10-2012-0203
  52. Tsoukas H. (1996). The firm as a distributed knowledge system: a constructionist approach. Strategic management journal, 17 (S2): 11-25. DOI: 10.1002/smj.4250171104
  53. Van Maanen J. (2011). Tales of the field: On writing ethnography. Chicago: University of Chicago Press. Villa S., Barbieri M., Lega F. (2009). Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases. Health Care Management Science, 12(2): 155-165. DOI: 10.1007/s10729-008-9091-6
  54. Vos L., Chalmers S. E., Duckers M.L., Groenewegen P.P., Wagner, C., van Merode G.G. (2011). Towards an organisation-wide process-oriented organization of care: a literature review. Implementation Science, 6:8. DOI: 10.1186/1748-5908-6-8
  55. Waring J.J., Bishop S. (2010). Lean healthcare: rhetoric, ritual and resistance. Social Science and Medicine, 71 (7): 1332-40. DOI: 10.1016/j.socscimed.2010.06.028
  56. Waltson S.L., Kimberley J.R. (1997). Reengineering hospitals: evidence from the field. Journal of ealthcare Management, 42 (2): 143.
  57. Wenger E. (1998). Communities of practice: Learning, meaning, and identity. Cambridge: Cambridge University Press.
  58. Yanow D. (2009). Organizational ethnography and methodological angst: myths and challenges in the field. Qualitative Research in Organizations and Management: An International Journal, 4(2): 186-199. DOI: 10.1108/1746564091097842
  59. Ybema S., Yanow D., Wels H., Kamsteeg F.H. (Eds.). (2009). Organizational ethnography: Studying the complexity of everyday life. London: Sage.

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Elisa Giulia Liberati, Aprire la black box dell’innovazione organizzativa: l’Intensità di Cura in pratica in "MECOSAN" 95/2015, pp 55-79, DOI: 10.3280/MESA2015-095004