Il costo dell’intervento chirurgico in laparoscopia con l’Activity Based Costing

The purpose of this research is to analyze the role of the Management Control System (MCS) and of the Management Accounting System (MAS) in healthcare (HC) organizations. It aims at studying if and how managerial considerations affect the clinical culture. Results are based on the findings of a research developed within 12 Local Health Authorities (Aziende Sanitarie Locali LHAs) and 4 Teaching Hospital (Aziende Ospedaliere Universitarie THs) in Italian Tuscany Region and address the possibility to develop an alternative model from those of accountingization or legitimation proposed in literature to understand the role of these systems in healthcare. Results highlight that the economic language may assume a great importance in clinicians’ decision making and penetrates into clinical culture. Most important factor affecting results is the development of an alliance between controllers and clinicians, based trust and collaboration. The paper is a contribution to the literature about the role of MCS and MAS in healthcare and it is developed within the schemes traced by Habermas and refined by Laughlin and by Broadbent and Laughlin. The original value stands on the individuation of a model where the “integrative interactive” management model is able to penetrate clinical discourse and the conditions at which it can be developed.Management Accounting Change, Management Control Change, Healthcare Accounting, Professional organization, accountinization, legitimation, Habermas

Management Accounting for Service: A Research Agenda

Purpose – The purpose of the paper is to point out a research agenda for Management Accounting under the emergent Service-Dominant (S-D) Logic. S-D Logic is widely discussed in the field of Marketing, the paper tries to extend S-D Logic in the Management Accounting context and develops some related considerations. Methodology/approach – Service related change in economy and firms raises new challenging issues in management accounting topics such as cost classification, cost structure, cost object, the role of “traditional” accounting tools and models, price-cost relations for pricing decisions. In this paper, we identify several critical research questions that address a tentative research agenda in the field of management accounting to better explore its role within service science. Throughout the paper many different examples are provided in order to support what is sustained. Findings – The conclusions of the paper trace some aspects addressed as core in the distinction between Goods-Dominant Accounting and Service-Dominant Accounting. Considering the new changing service environment, the role of management accounting in providing information to support managerial decision making and control can be widely renewed. Research implications – The paper opens many underexplored topics on Management accounting in the interface with service and traces a research agenda for further research. Originality/value – This is the first paper, after the brief overview on accounting and Service Science provided by Kerr (2008), aiming at understanding the role of Management accounting in the context of S-D Logic.Service-Dominant Logic, Management Accounting, Costing, Measurement, Value.

Designing manufacturable viscoelastic devices using a topology optimization approach within a truly-mixed fem framework

A new approach to topology optimization is presented that is based on the minimization of the input/output transfer function H∞norm. Additionally, by properly selecting input and output vector, the approach is recognized to minimize an entirely new definition of frequency-based dynamic compliance. The method is applied to viscoelastic systems in plane strain conditions that are investigated by using the Arnold-Winther finite-element resorting to a generalized solid phenomenological model. Preliminary indications on how to address the actual manufacturability of the optimal specimen are eventually outlined

Designing performance measurement systems in health care: multiple organizational players and their interaction in the case of the prevention services in tuscany.

The designing of a performance measurement system usually involves several players, the number and the role of the players in building new performance measurement tools depending on the features affecting the type of organization. Among them, health care units can be considered as some of the most complex to manage (“Running even the most complicated corporation must sometimes seem like child’s play compared to trying to manage almost any hospital.”, Mintzberg and Glouberman 2001), being based on professionals’ activity. Professionals play a wide span of autonomy and they can resist towards changes and control systems that do not involve them, thus implicating their deep involvement in designing and implementing effective management control devices. Due to this characteristic, the decision makers about measurement systems in public health are not only the politics and top managers at different levels (national, regional and local) but also the professionals at their level. But which are the roles of these players at their organizational levels? Do they play a different role in desing and implementation of a performance measurement system? And which are the interactions among them? The aim of this paper is to answer at these questions through the experience of the design of the so-called Prodotti Finiti system for measuring output and performance of the prevention services in Tuscan health care system. The necessity of this performance measurement system rises from a lack that regards the primary care and the collective prevention services: while in the hospital services the DRGs system has been developed and used as a shared tool to measure output and performance, in the primary care and the collective prevention services there is no shared and uniform way to measure the services provided. The idea of using the Prodotti Finiti (Final Products) as objects of performance measurement of prevention services was born at a local level in 1998; then, in 2006, it was spread to all LHAs by the regional level in order to have a uniform and shared system. The players involved in this initiative have been the local and regional levels as the promoter of the introduction of the Prodotti Finiti system and the groups of professionals as the decision-makers of what products and what elements should have to be measured. In the experience of the design of this system the professionals seem to have been the strongest decisional level: they have decided what were the objects to be measured. The political levels (regionals and local) could choose to limit the analysis to some products (as key performance areas) or to some particular elements of the products but these were second hand choices because strictly linked to the assumptions and the decisions already made by professionals. Although the choice of involving professionals in the design of the measurement system is fundamental for the consensus, it could lead to a limited power of the other decision makers, so confirming the strenght of professionals’ power in designing performance measurement systems in health care organizations.performance measurement, public health, multiple players

Do management accounting systems influence organizational change or vice-versa? Evidence from a case of constructive research in the Healthcare Sector

The paper aims to analyze the process of change of management accounting system (MAS) as a consequence of changes in the complexity of organizational structure in healthcare. It analyzes the process of change of MAS according with the theoretical frameworks of Habermas (1987) and Laughlin (1991).In this organizational changes are seen as the consequence of the interaction between tangible and intangible elements of the organization and between the organization and the external environment. The process of change was not studied from an external standpoint, but through an active participation and contribution of the researchers in the process of change itself. Using a constructive approach, the researchers were actively involved with the actors of the change in developing the process of change, and in facilitating the overcoming of some cultural gaps and resistance which could arise in professional organization. The paper provides empirical insights of the characteristics of the process of change of MAS in a Heath Care setting with a particular focus on aspects characterizing the process of change itself. Finding suggests the importance of putting high attention in the development of the process of change and underlines how the attention to peculiarities of the organization, in to this phase, could make the MAS able to impact on the behaviours and culture of professionals.Management Accounting Change, Healthcare Accounting, Habermas

Origini, evoluzione e declino della Provincia nell'ordinamento italiano.

La presente tesi tratta della istituzione “Provincia” dalle sue origini fino ad oggi. Vengono descritte le prime forme di questa istituzione che, nell’età contemporanea, vede il suo sorgere nel periodo napoleonico. La conformazione giuridica della Provincia viene fissata dalla legge “Rattazzi” del 1859 del Regno di Sardegna, che verrà poi trasfusa nella legge comunale e provinciale del 1865 del neonato Regno di Italia. La Provincia è sempre stata uno strumento di decentramento burocratico dello Stato ed un ente autonomo avente per finalità la cura degli interessi di un determinato territorio e dei suoi abitanti. Il presente lavoro si occupa della Provincia quale ente autonomo e ne traccia i momenti salienti della sua vita, contraddistinta da periodi di maggiore e minore importanza nel contesto politico nazionale e locale e nell’ordinamento giuridico. Viene fatto cenno alla discussione relativa a tale ente avvenuta in sede di Assemblea costituente, dove si registrarono prese di posizione tendenti alla sua soppressione, ma dove, invece, l’istituzione si guadagnò la qualifica di ente di rilievo costituzionale. Pochi anni dopo la fine della seconda guerra mondiale, il Consiglio provinciale, massimo organo dell’ente, riacquista la sua qualità di organo eletto democraticamente a seguito libere elezioni. Si arriva così al 1990 quando la legge n. 142/90 conferisce alla Provincia un nuovo ruolo di ente di programmazione e coordinamento, contribuendo a decretarne in un certo senso la rinascita. Un nuovo riconoscimento di ente costituente, insieme agli enti locali, la Repubblica, viene ottenuto dalla Provincia con la riforma costituzionale del 2001. A decorrere dall’anno 2009 vengono emanate norme tendenti a ridurre i costi della politica. In questo quadro l’ente territoriale che ne fa maggiormente le spese è proprio la Provincia che vede ridurre sensibilmente la sua rappresentatività in termini democratici e l’attribuzione delle sue funzioni. Si arriva in tal modo all’emanazione della legge n. 56/2014 (Del Rio) con la quale, in attesa della riforma costituzionale Renzi-Boschi, viene finalmente definito in maniera organica l’assetto della Provincia quale ente di area vasta. I suoi organi saranno nominati in secondo grado e le sue funzioni saranno ridotte notevolmente. Con l’approvazione della riforma costituzionale da parte dei due rami del Parlamento, che ha concluso il suo iter nell’aprile scorso, la Provincia perde la sua qualità di ente previsto dalla Costituzione. Poiché la legge sarà sottoposta a referendum popolare, sarà l’esito di questo a determinarne la sorte