The Challenges of Hospitals' Planning & Control Systems: The Path toward Public Value Management.

Sabina Nuti,Tommaso Grillo Ruggieri,Guido Noto,Milena Vainieri

doi:10.3390/ijerph18052732

Abstract

In the last decades, public management has been subjected to a shift from the New Public Management (NPM) paradigm to the Public Value Management (PVM) one. Thus, management practices such as Planning and Control (P&C) systems have been called to evolve accordingly. The health care sector has not escaped this process. This paper focuses on the evolution of hospitals’ P&C systems to support the paradigm shift from the NPM paradigm to the PVM one. In particular, the paper aims at exploring whether hospitals’ P&C systems in Italy evolved, or are evolving, consistently with PVM and what are the expected benefits related to such a paradigm switch. To address the research aim, the paper is based on a review of scientific and grey literature and the case study of the diabetic-foot pathway in an Italian Regional Healthcare System. The results of this study show that the current P&C systems in Italian hospitals are not yet designed to support the shift toward the PVM approach and are still mainly focused on financial aspects and intra-organizational dynamics. Combining traditional P&Cs with performance measures assessing the system’s outcomes may support hospitals in aligning their goals with the health system they are operating within and, therefore, P&C systems may represent an important driving force toward change. Such results provide suggestions for both practitioners and academics on how to adapt P&C systems to better support the implementation of current strategies of the public sector.

Highlights

Over the last thirty years, New Public Management (NPM) reforms have drastically changed the role and the way public sector institutions are managed [1]
Managerialism was aimed at orienting public sector organization’s structure, financial management, staffing, and rewards toward the achievement of better outputs and productivity. It was modeled on the multidivisional form of private-sector corporations of the 1980s, i.e., breaking organizations down into various business units which were controlled by setting and monitoring performance results [3]. This led to the adoption of the first Planning and Control (P&C) systems which, according to Amigoni [4] may be defined as those set of
To answer the research questions, this paper focuses on the role of P&C systems in hospital organizations in Italy

Summary

Introduction

Over the last thirty years, NPM reforms have drastically changed the role and the way public sector institutions are managed [1] These reforms were aimed at addressing the shortcomings of the traditional paradigm of Public Administration, based on Weber’s model of ideal bureaucracy [1]. Managerialism was aimed at orienting public sector organization’s structure, financial management, staffing, and rewards toward the achievement of better outputs and productivity. It was modeled on the multidivisional form of private-sector corporations of the 1980s, i.e., breaking organizations down into various business units which were controlled by setting and monitoring performance results [3]. This led to the adoption of the first P&C systems which, according to Amigoni [4] may be defined as those set of

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Discussion

Conclusion