Multidimensional evaluation of performance: experimental application of the balanced scorecard in Ferrara university hospital

<p>Abstract</p> <p>Background and Aims</p> <p>One of the best-known performance planning and evaluation techniques utilising both monetary and non-monetary data is the <it>Balanced Scorecard (BSC)</it>. This is a means of rationalising the global activity of a business in the attempt to create value, and to translate the company vision into a set of tactical objectives and measurable strategies. The aim of this study was to implement and evaluate the use of BSC in two departments of the St. Anna University Hospital, Ferrara: the Analysis Laboratory and Digestive Endoscopy operating units (OU).</p> <p>Materials and methods</p> <p>With the collaboration of the health workers involved, a precise methodological programme was pursued: Definition of the strategic map from 4 perspectives, according to Kaplan and Norton, Definition of the Key Performance Areas (KPA), or macro-objectives, Identification of the cause-effect relationships between KPAs, Identification of the sub-objectives of each KPA, Definition of the Key Performance Indicators (KPI), Definition of the weight/importance of each objective in the global evaluation.</p> <p>Results</p> <p>The information gathered permitted the definition of macro- and sub-objectives for each perspective, as well as determining the relevant indicators, standards, weights, frequency of detection and means of acquisition. Strategic maps showing the cause/effect relationships in each OU were created, as were 'evaluation panels', which describe the global performance of each department. For each perspective, the fundamental data were summarised in one table. Evaluation of each perspective yielded a positive result for the majority of the objectives, and the global result (including all 4 perspectives) was found to be satisfactory.</p> <p>Discussion-Conclusion</p> <p>The Balanced Scorecard was implemented in the abovementioned OUs of St. Anna University Hospital, Ferrara, after the health workers themselves realised the need for change.</p> <p>In our research the employees were pleased to be evaluated, not only for the financial outcomes, but also for the satisfaction of improving internal procedure, relationships with the community and their own growth/learning. BSC is an ideal point of contact between the financial and clinical dimensions of management. However, difficulties in its application were faced, among these, at least in the initial phase, the lack of information systems able to drive it, and the complexity of the research for specific indicators needed to be overcome. The time factor (on average, at least two years are required) and the availability of technological resources were also limiting factors.</p> <p>The rapid diffusion of BSC among the principal international profit and non-profit organisations is testament to its great potential. This project could be seen as a preparatory phase in the strategical analysis of a subsequent business plan.</p

Multidimensional evaluation of performance with experimental application of balanced scorecard: a two year experience

<p>Abstract</p> <p>Background</p> <p>In today's dynamic health-care system, organizations such as hospitals are required to improve their performance for multiple stakeholders and deliver an integrated care that means to work effectively, be innovative and organize efficiently. Achieved goals and levels of quality can be successfully measured by a multidimensional approach like Balanced Scorecard (BSC). The aim of the study was to verify the opportunity to introduce BSC framework to measure performance in St. Anna University Hospital of Ferrara, applying it to the Clinical Laboratory Operative Unit in order to compare over time performance results and achievements of assigned targets.</p> <p>Methods</p> <p>In the first experience with BSC we distinguished four perspectives, according to Kaplan and Norton, identified Key Performance Areas and Key Performance Indicators, set standards and weights for each objective, collected data for all indicators, recognized cause-and-effect relationships in a strategic map. One year later we proceeded with the next data collection and analysed the preservation of framework aptitude to measure Operative Unit performance. In addition, we verified the ability to underline links between strategic actions belonging to different perspectives in producing outcomes changes.</p> <p>Results</p> <p>The BSC was found to be effective for underlining existing problems and identifying opportunities for improvements. The BSC also revealed the specific perspective contribution to overall performance enhancement. After time results comparison was possible depending on the selection of feasible and appropriate key performance indicators, which was occasionally limited by data collection problems.</p> <p>Conclusions</p> <p>The first use of BSC to compare performance at Operative Unit level, in course of time, suggested this framework can be successfully adopted for results measuring and revealing effective health factors, allowing health-care quality improvements.</p

La gestione del rischio in agricoltura: l'uso degli strumenti assicurativi in Italia

The agricultural activity, in comparison to other productive activities, it is more subject to the problems of risk and uncertainty that can engrave deeply on the result economic ending. The agricultural entrepreneur, besides the tied up risks to his own activity, it has to face those caused by unfavorable climatic events, as a result of the place in which the most greater part of the agricultural activities are made. Actually to today Italian farmers had been able to count on a system of public indemnify for the damages, every time when these have been provoked from natural and atmospheric calamity. Recently however the Community Agricultural Politics has replaced the various measures of support of the management of the markets and the prices with a system of direct decoupling payments, breaking that strong bond that united the direct payments to the type and the volume of production. The present job sets the attention on the available tools for the management of the risks in agriculture actually, with particular reference to those concerning insurances

Precision farming: what do Italian farmers really think? An application of the Q methodology

Precision farming (PF) is a term that is now widespread throughout agricultural systems worldwide. It is studied in many ways, from its strictly technical connotation of a farm management strategy that uses information technology to support decision-making processes to the steppingstones and the dissection of the factors involved in the complex scenario of adopting related tools. Starting from the statement "In my opinion, precision farming is…", the present work investigates the perspective of the agricultural entrepreneur in conceptualising PF. Some researchers have highlighted the role of the sphere of the self in adoption, but few efforts have been made to better understand the role played by farmers’ perceptions in the formation of their thinking about innovative tools. This work aims to deepen the sphere of the self and, in particular, the role played by farmers’ perceptions when faced with the innovation adoption choice. The study presents a new conceptual framework identifying key stages for analysing adoption processes, focusing on the relationships between behaviour, structural dimensions and adoption, interpreted from the farmer perspective. The Q methodology (QM) was used with a targeted sample of 23 farmers to identify prevailing discourses. In the first step, the socio-structural dimensions were analysed through descriptive analysis, and in the second step, the discourses were extracted by an intercorrelation matrix through the centroid procedure, translating the solution using varimax rotation. This paper highlights that the QM is an appropriate technique for exploring and studying farmers’ attitudes when challenged with innovation. The results reveal discourses that summarise three macro perspectives: the “proactive approach”, which represents farmers who perceive PF as having a key role for agricultural enterprises; the “conservative approach”, which characterises those who distrust innovations; and the “doubtful approach”, which is the more sceptical vision

What is the role of locoregional anesthesia in breast surgery? A systematic literature review focused on pain intensity, opioid consumption, adverse events, and patient satisfaction

Breast surgery in the United States is common. Pain affects up to 50% of women undergoing breast surgery and can interfere with postoperative outcomes. General anesthesia is the conventional, most frequently used anaesthetic technique. Various locoregional anesthetic techniques are also used for breast surgeries. A systematic review of the use of locoregional anesthesia for postoperative pain in breast surgery is needed to clarify its role in pain management

COVID-19 in Low- and Middle-Income Countries (LMICs): A Narrative Review from Prevention to Vaccination Strategy

The management of the COVID-19 pandemic represents a challenging process, especially for low- and middle-income countries (LMICs) due to the serious economic and health resource problems it generates. In this article, we assess COVID-19 situation in LMICs and outline emerging problems and possible solutions. The prevention and control of COVID-19 would be based on focused tests exploiting those systems (e.g., GeneXpert®) already used in other scenarios. This would be less stressful for the healthcare system in LMICs. Avoiding close contact with people suffering from acute respiratory infections, frequent handwashing, and avoiding unprotected contact with farm or wild animals are recommended infection control interventions. The appropriate use of personal protective equipment (PPE) is required, despite its procurement being especially difficult in LMICs. Patients’ triage should be based on a simple and rapid logarithm to decide who requires isolation and targeted testing for SARS-CoV-2. Being able to estimate which patients will develop severe disease would allow hospitals to better utilize the already limited resources more effectively. In LMICs, laboratories are often in the capital cities; therefore, early diagnosis and isolation become difficult. The number of ICU beds is often insufficient, and the equipment is often old and poorly serviced. LMICs will need access to COVID-19 treatments at minimal prices to ensure that all who need them can be treated. Year-to-date, different vaccines have been approved and are currently available. The main obstacle to accessing them is the limited ability of LMICs to purchase significant quantities of the vaccine

Cefiderocol for Carbapenem-Resistant Bacteria: Handle with Care! A Review of the Real-World Evidence

(1) Background: healthcare-associated infections are one of the most frequent adverse events in healthcare delivery worldwide. Several antibiotic resistance mechanisms have been developed, including those to carbapenemase. Cefiderocol (CFD) is a novel siderophore cephalosporin designed to treat carbapenem-resistant bacteria. (2) Methods: we performed a systematic review of all cases reported in the literature to outline the existing evidence. We evaluated real-world evidence studies of CFD in the treatment of carbapenem-resistant (CR) bacteria. (3) Results: a total of 19 publications treating cases of infection by CR bacteria were included. The three most frequent CR pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. A regimen of 2 g every 8 h was most frequently adopted for CFD with a mean treatment duration of 25.6 days. CFD was generally well tolerated, with fewer side effects. The success rate of CFD therapy was satisfactory and almost 70% of patients showed clinical recovery; of these, nearly half showed negative blood cultures and infection-free status. (4) Conclusions: This review indicates that CFD is active against important GN organisms including Enterobacteriaceae, P. aeruginosa, and A. baumannii. CFD seems to have a safe profile

Erectile Dysfunction in the Elderly: An Old Widespread Issue with Novel Treatment Perspectives

Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed