Responding to COVID – 19: Insight Into Capability Re-Configuration of Healthcare Service Ecosystems? The Use Case of Hospitalization at Home

An effective Healthcare Service Ecosystem must emphasize the notion of well-being co-creation which entails a dynamic interplay of actors, in face of the challenges, with their ability to use the available resource pools, at the different system levels. An appropriate response, largely avoiding any crisis, depends on a society's resilience and the related response of actors in the reconfiguration of resources. Originally considered luxury and for the fortunate few who could afford the learning curve, Hospitalization-at-Home (HaH) recently approached a new normal with a positive impact to health outcomes. Nowadays, hospitals have had to reconfigure their health services to reduce the workload of caregivers during the COVID-19 outbreak. We show an example of how HaH can be a viable re-configuration of Healthcare Service Ecosystems and a use case for capability reconfiguration. Our use case can be a lesson for the adaptation of technology for patient empowerment allowing patients to interact with their care ecosystem while at their home

Intelligent Systems 3. Knowledge Engineering 4. Collaborative Filtering 5. System Thinking 1 Full Professor of Computer Science, Salerno University, [email protected]. 2 Full Professor of Electrical and Electronic Measurements

ABSTRACT Purpose -The general concept of a Service System is now used to refer to those complex systems composed of heterogeneous entities, including people, technology and business operations, which interact through the exchange of services. The aim of this paper is to introduce the concept of Knowledge Based Service Systems and demonstrate that the way to make an economic, managerial, organizational, industrial, computer system smarter, which means that the system evolves by adapting to the needs and changing conditions thereby reducing the mismatch and loss of resources, is to consider such a system as a Service System based on the management and manipulation of Knowledge. Methodology/approach -To achieve a dynamic and adaptive system, we need a description of the system, entities and services, as well as a definition of the structured knowledge based on ontologies, metadata, taxonomies and thesauri, and so a kind of Knowledge Representation which contains both the raw data, obtained by recording the behavior of the system, and the knowledge gained through the study of the domain. Consequently, we need to design a Data Mining and Knowledge, Inference and Learning system, that is capable of working on both the raw and structured data and so bringing both understanding and prediction, with the aim of making the system able to adaptively evolve thereby reducing the mismatch in the services exchange mechanism. Findings -It will be fundamental to exploit results obtained by the scientific community in the field of probabilistic methods for Collaborative Filtering which are based on techniques suitable for handling data belonging to the lowest level of the knowledge hierarchy (memory based), at the intermediate level (content based) and at the highest level (hybrid). Research implications -This work can be considered as a Service Research advance in Knowledge based Service Systems. Practical implications -Such a system could be implemented in every context in order to improve the management of available resources. Originality/value -What is asserted in this paper could be interesting when it is necessary to reduce the mismatch in the service exchange process: management of alternative and/or sustainable energy systems, of agriculture and the environment, of heritage and artistic systems, of sustainable mobility, of homeland security, of health and life sciences

A4A relationships

Purpose The purpose of this paper is to investigate the characteristics of actors that allow them to relate to others actors in the system through shared intentionality (orientation) and the nature of the A4A relationship and the results that such interactions bring to the emergent system based on this shared purpose (finality). Design/methodology/approach The topic is approached by theoretical analysis and conceptual development of three integrative frameworks: the sociological perspective, service-dominant logic and a particular perspective of system thinking: the viable system approach (vSa). Findings The A4A relationships involve value co-creation based on actors integrating their resources and acting with intentionality to obtain value by providing benefits to other parties and by belonging to the emergent viable system; actor acts for other actors directly involved in the relationship generating positive effects for the whole system in which it is contextualized. Research limitations/implications Future empirical research might better support findings. Social implications Many social implications deriving from an augmented role of actors engaged within social relationships in co-creation exchanges. From the title of the paper A4A over on the manuscript describes numerous social inferences of actors in co-creation. Originality/value A4A is a relationship formed by actors that interact for the benefit of the whole system in which are involved. They find own benefit from the benefit created for the system in which they live and act. In A4A relationships the value of the single actor comes from the participation to the viability of the whole system.acceptedVersio

Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy : a prospective assessment of patient scar satisfaction

Published online: 26 October 2014PURPOSE: To compare patient scar satisfaction after retropubic, standard laparoscopic, mini-laparoscopic (ML) and open radical prostatectomy (RP). METHODS: Patients undergoing RP for a diagnosis of localized prostate cancer at a single academic hospital between September 2012 and December 2013 were enrolled in this prospective nonrandomized study. The patients were included in three study arms: open surgery, VLP and ML. A skin stapler was used for surgical wound closure in all cases. Demographic and main surgical outcomes, including perioperative complications, were analyzed. Surgical scar satisfaction was measured using the Patient and Observer Scar Assessment Questionnaire (POSAS) and the two Body Image Questionnaire (BIQ) scales, respectively, recorded at skin clips removal and either at 6 months after surgery. RESULTS: Overall, 32 patients were enrolled and completed the 6 month of follow-up. At clips removal, laparoscopic approaches offered better scar result than open surgery according to the POSAS. However, at 6 months, no differences were detected between VLP and open, whereas ML was still associated with a better scar outcome (p = 0.001). This finding was also confirmed by both BIQ scales, including the body image score (ML 9.8 ± 1.69, open 15.73 ± 3.47, VLP 13.27 ± 3.64; p = 0.001) and the cosmetic score (ML 16.6 ± 4.12, open 10 ± 1.9, LP 12.91 ± 3.59; p = 0.001). Small sample size and lack of randomization represent the main limitations of this study. CONCLUSIONS: ML RP offers a better cosmetic outcome when compared to both open and standard laparoscopic RP, representing a step toward minimal surgical scar. The impact of scar outcome on RP patients' quality of life remains to be determined

La Service Dominant Logic ed una sua interpretazione al fenomeno turistico

Nell’attuale scenario competitivo, i servizi pervadono oramai tutte le attività economiche, coinvolgendo qualsivoglia sistema produttivo e qualsiasi organizzazione. L’emergente importanza dei servizi rispetto ai beni, tradizionalmente intesi, ed il ruolo determinante agito dagli stessi nell’ambito di tutte le transazioni economiche nella global economy stimola studiosi, professionisti ed esperti di business, ad impegnarsi nella ricerca di modelli, paradigmi e costrutti teorici in grado di descrivere con più efficacia i nuovi processi di generazione di valore. In quest’ottica la Service-Dominant Logic (in seguito anche S-D Logic), recentemente introdotta nel panorama scientifico internazionale da Vargo e Lusch, rappresenta un cambio di prospettiva rispetto ai paradigmi tradizionali, in grado di rovesciare il legame esistente tra beni e servizi, rivisitando le considerazioni connesse al loro scambio ed al conseguente uso, rileggendo i concetti del valore e della sua creazione, reinterpretando i significati di interazione, relazione e fidelizzazione. L’applicabilità delle congetture e del costrutto teorico della S-D Logic è del tutto generale; esso, per sua natura aspira a rappresentare un nuovo modello interpretativo delle logiche di business della global economy. Perché non provare, pertanto, ad interpretarne i concetti nell’ambito di una economia, quella turistica, nell’ambito della quale così importante è la componente di servizio? Il fenomeno turistico, d’altronde, risulta continuamente soggetto a fenomeni evolutivi in funzione delle peculiarità intrinseche del proprio “prodotto”, (realizzazione, erogazione, diffusione, innovazione, durata) che favoriscono ripetute variazioni interpretative e numerosi cambiamenti di prospettiva. Il presente contributo3 intende ripercorrere i tratti salienti del paradigma S-D Logic nel tentativo di rappresentarne i relativi fondamenti per poi trasporli nell’interpretazione del fenomeno turistico, visto nel suo complesso. Tale studio parte dunque dalla disamina dei contenuti proposti dai principali autori della S-D Logic (Vargo e Lusch), nonché da coloro che principalmente da essi hanno tratto ispirazione, per poi caratterizzarne i costrutti teorici mediante l’interpretazione degli stessi al business turistico al fine di contestualizzare i risultati della nuova visione, nell’ottica condivisa di un approccio relazionale al business, e più in generale coerente con l’approccio sistemico vitale. Keywords: Service dominant logic, turismo, RBV, approccio relazionale, co-creazione del valore, networks

ECO-SISTEMI DI SERVIZIO IN SANITA'

Lo studio delle dinamiche complesse che caratterizzano il Servizio Sanitario Nazionale del nostro Paese, così come in altre Nazioni, rappresenta un importante approfondimento a supporto del miglioramento dei processi decisionali ed in quelli organizzativi in un ambito considerato di estremo interesse per l'intera Comunità. Il presente lavoro mostra significativi e originali contributi scientifici utili alla comprensione del funzionamento e delle interazioni tra i vari attori che oggi operano nell'SSN; vengono evidenziati aspetti rilevanti sia sotto il profilo strutturale che sotto il profilo comportamentale (quindi sistemico), a beneficio di una interpretazione maggiormente integrata ed integrante di molti fenomeni tipici di ciò che viene in questa sede definito eco-sistema di servizio sanitario analizzato nel suo complesso, il tutto grazie anche al framework di riferimento relativo agli avanzamenti nella Service Research e System Thinking. Il lavoro si inquadra all'interno di un'indagine più ampia che da tempo viene condotta da questo Gruppo di Ricerca nel tentativo di addivenire ad una terminologia davvero unificante e a contenuti sempre più consolidati sul tema della Sanità in ottica sistemica e service-centred. Tra i vari elementi di rilievo, vengono qui approfondite le determinanti e le pre-condizioni del fenomeno del Patient Empowerment e di una delle sue più interessanti estrinsecazioni rappresentata dal processo di de-ospedalizzazione in atto in diverse Regioni d'Italia. I risultati applicativi del lavoro riguardano l'interno servizio sanitario e possono concretamente stimolare tutti gli Attori coinvolti a contribuire fattivamente al miglioramento del livello generale di performance, nell'interesse anzitutto dei Pazienti, e conseguentemente ad alimentare il processo di co-generazione di valore, così come dagli stessi Pazienti viene percepito. Parole chiave: Eco-sistema di servizio, co-creazione di valore, Servizio Sanitario Nazionale, Patient Empowerment, de-ospedalizzazion