Patient characteristics associated with the acceptability of teleconsultation: a retrospective study of osteoporotic patients post-COVID-19

Background: Due to the COVID-19 pandemic, teleconsultations (TCs) have become common practice for many chronic conditions, including osteoporosis. While satisfaction with TCs among patients increases in times of emergency, we have little knowledge of whether the acceptability of TCs persists once in-person visits return to being a feasible and safe option. In this study, we assess the acceptability of TCs across five dimensions for osteoporosis care among patients who started or continued with TCs after the COVID-19 pandemic had waned. We then explore the patient characteristics associated with these perceptions. Methods: Between January and April 2022, 80 osteoporotic patients treated at the Humanitas Hospital in Milan, Italy, were recruited to answer an online questionnaire about the acceptability of TCs for their care. The acceptability of TCs was measured using a modified version of the Service User Technology Acceptability Questionnaire (SUTAQ), which identifies five domains of acceptability: perceived benefits, satisfaction, substitution, privacy and discomfort, and care personnel concerns. Multivariable ordinary least squares (OLS) linear regression analysis was performed to assess which patient characteristics in terms of demographics, socio-economic conditions, digital skills, social support, clinical characteristics and pattern of TC use were correlated with the five domains of acceptability measured through the SUTAQ. Results: The degree of acceptability of TCs was overall good across the 80 respondents and the five domains. Some heterogeneity in perceptions emerged with respect to TCs substituting for in-person visits, negatively impacting continuity of care and reducing the length of consultations. For the most part, acceptability was not affected by patient characteristics with a few exceptions related to treatment time and familiarity with the TC service modality (i.e., length of osteoporosis treatment and number of TCs experienced by the patient). Conclusions: TCs appear to be an acceptable option for osteoporosis care in the aftermath of the COVID-19 pandemic. This study suggests that other characteristics besides age, digital skills and social support, which are traditionally relevant to TC acceptability, should be taken into account in order to better target this care delivery modality

Unpacking hybridity: development and first validation of a multidimensional instrument to profile hybrid professionals

Hybrid professionals, that is, professionals who have transitioned to managerial roles, have emerged in numerous public settings. Through in-depth qualitative methodologies, the literature has shown a good degree of heterogeneity in the way hybrid professionals perceive and manage their hybridity. In this study, we aim to develop a theory-based, multidimensional instrument able to capture such heterogeneity in a lean but sensitive way. In this instrument, we combine consolidated scales of identity centrality and integration and vignettes, on the one hand, to measure the perception of hybrid professionals of the relationship between their professional and managerial identities and, on the other hand, to elicit the practices they use to deal with the demands of the professional and managerial logics. We first validate the instrument on a sample of school principals in the Italian context and then describe the six profiles of hybrid professionals derived from the analysis. We suggest three avenues for applying such an instrument

Response to COVID-19: was Italy (un)prepared?

On 31st January 2020, the Italian cabinet declared a 6-month national emergency after the detection of the first two COVID-19 positive cases in Rome, two Chinese tourists travelling from Wuhan. Between then and the total lockdown introduced on 22nd March 2020 Italy was hit by an unprecedented crisis. In addition to being the first European country to be heavily swept by the COVID-19 pandemic, Italy was the first to introduce stringent lockdown measures. The SARS-CoV-2 outbreak and related COVID-19 pandemic have been the worst public health challenge endured in recent history by Italy. Two months since the beginning of the first wave, the estimated excess deaths in Lombardy, the hardest hit region in the country, reached a peak of more than 23,000 deaths. The extraordinary pressures exerted on the Italian Servizio Sanitario Nazionale (SSN) inevitably leads to questions about its preparedness and the appropriateness and effectiveness of responses implemented at both national and regional levels. The aim of the paper is to critically review the Italian response to the COVID-19 crisis spanning from the first early acute phases of the emergency (March-May 2020) to the relative stability of the epidemiological situation just before the second outbreak in October 2020

Life beyond emergence: Institutional intermediaries and the persistence of hybrid forms

We report on a multi-level longitudinal study investigating a population of public-private hybrid organizations in the Italian healthcare field, where a public service and quasi-market logic coexist. A combination of survey, interviews and archival data allowed us to trace the dynamics of persistence and decay of two hybrid templates over 25 years (1992-2016). By bridging the literature on institutional complexity and hybrids with insights from imprinting, we illuminate the role of field-level actors (regional authorities) who as institutional intermediaries and agents of recursive imprinting embed their prioritization of institutional logics in distinct templates for organizing, and provide them to hybrid organizations during multiple sensitive periods over time. Our findings draw attention to the differential institutional capacity of institutional intermediaries to prioritize and enforce institutional logics, and to the diverse relational, procedural and discursive mechanisms they employ during imprinting processes. Ultimately, our findings advance the understanding of how certain hybrid forms come to persist while others decay

Analisi del sistema di finanziamento della ricerca sanitaria in Italia

Analisi dei modelli di finanziamento della ricerca sanitaria; focus sulla ricerca finanziata dal Ministreo della Salute e ruolo degli ospedali IRCCS; comparazione intrenazionale con Germania, Francia e Inghilterr

Explaining the unexpected success of the smoking ban in Italy: political strategy and transition to practice (2000-2005)

The approval (2003) and enforcement (2005) of a smoking ban in Italy have been viewed by many as an unexpectedly successful example of policy change. The present paper, by applying a processualist approach, concentrates on two policy cycles, between 2000 and 2005, which had opposing outcomes: an incomplete decisional stage and an authoritative decision, enforced two years later. Through the analysis of the different phases of agenda setting, alternative specification and decision-making we have compared the quality of participation of policy entrepreneurs in the two cycles, their political strategies and, in these, the relevance of issue image. The case allows us to attract the attention of scholars and practitioners to an early phase of the policy implementation process, that we named ‘transition to practice’, which, managed with political astuteness, might have strongly contributed to the final successful policy outcome

How early implementations influence later adoptions of innovation: social positioning and skill reproduction in the diffusion of robotic surgery

We report from a multi-level study investigating the diffusion of robotic surgery in the Italian health care system between 1999 and 2010. A combination of qualitative and quantitative methods allowed us to link organization-level processes associated to the adoption and implementation of the innovation with its diffusion at population level. Our findings advance our understanding of how early implementations influence later adoptions, by drawing attention to how search for social gains pushes some peripheral actors to pioneer a new technology or work practice, and to engage in practices of discursive persuasion and skill reproduction that constitute them as ‘exemplary users’ and that may eventually trigger and support isomorphic diffusion even in the presence of persisting uncertainty about the technical and/or economic benefits of the innovation

Maintaining strategic ambiguity for protection: struggles over opacity, equivocality and absurdity around the Sicilian Mafia

In spite of an increasing interest in ambiguity, our knowledge of how organizations maintain strategic ambiguity to protect themselves from public scrutiny is still in its infancy. Through an in-depth historical study of the Sicilian Mafia between 1963 and 2018, we develop a model of strategic ambiguity maintenance. We focus on three struggles between the Mafia and state representatives and show how they centered on different types of ambiguity: ambiguity as opacity, equivocality and absurdity. We elaborate on the strategies enacted by the Mafia and the responses by state representatives and their implications for ambiguity over time. The main contribution of our paper is that it advances understanding of the maintenance of strategic ambiguity by organizations that need to protect themselves from public scrutiny. More specifically, it enriches understanding of the key process dynamics, the type of struggles, and the discursive and non-discursive strategies employed in the process. Our analysis also extends research on clandestine organizations and illuminates the relationship between (strategic) ambiguity and secrecy

Italy: experiences of multi-level governance with the COVID-19 crisis

Italy has been the first European country to be dramatically affected by COVID-19. As of June 2020, the epidemic counts almost 240,000 cases and a staggering number of over 34,000 deaths. The central government established a progressive and harsh lockdown of all non-essential social and economic activities, prioritizing health issues. Given their established co-responsibility on health policy and the uneven spread of the virus throughout the country, regional authorities undertook further prevention actions independently and often in an uncoordinated way. Most of the policy decisions were shown to be informed by clinical experts, who assumed a great visibility with the public since the early phases of the crisis. Public healthcare managers were much less visible but took relevant decisions in very short timespans, filtering a multitude of policy inputs and communication noise. More particularly, they provided a space for action, coordinated multiple stakeholders and professionals of different backgrounds, and played a crucial role in service redesign, human resource management and logistics