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

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

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

Cost Measurement in Laparoscopic Surgery: Results from an Activity-Based Costing Application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully appl ied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their eco nomic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introdu ction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusio n of ABC techniques in this service sector.Activity-Based Costing; Economic assessment of surgery techniques

Cost measurement in laparoscopic surgery: results from an activity-based costing application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully applied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their economic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introduction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusion of ABC techniques in this service sector.Activity-Based Costing, Economic assessment of surgery techniques

The gender budget as a tool for gender equality? : Analysing its effectiveness through the lens of pragmatic constructivism

This paper investigates which values are communicated by public universities through the elaboration of gender budgets and whether and how coherence is built with the respective performance measurement systems. In a society where increasing pressures are put by national and international institutions to guarantee gender equality and fight against any kind of discrimination, universities are expected to play a key role in pursuing such goals and support the development of a culture of integration, respect, and equal opportunities. Among the different initiatives, universities are adopting a gender budget to allocate resources and plan specific activities to achieve gender equality. To account for the results achieved and monitor whether the results are aligned with the expectations and the stated objectives, sound performance measures are required. In this regard, the current research analyses the content of three different gender budgets elaborated by Italian universities in order to investigate whether the performance measures and narratives adopted are aligned with the stated goals and values communicated, thus being able to guide universities toward gender equality

Understanding performance measurement in public organization under pragmatic constructivism

The aim of this paper is twofold. Firstly to explore how a constructivist pragmatic approach may be applied to understand critical aspects of performance measurement in a public organization. And secondly, to contribute in proposing some effective characteristics of the potential PMS in the same setting. To this aims we analyze how different topoi may cohabit in a Regional Authority. This topic is particular important because the convergence of different topoi is crucial for the achievement of common organizational visions and to achieve organizational goals. The investigation of topoi was supported by interviews and focus groups that involved two organizational positions of an Italian Regional Authority: Top Managers and Middle Managers. These two organizational positions were chosen because they perform different types of activities and hence we can expect different topoi. The aim of interviews and focus group was to trace values, facts, logic and communication that form the topos driving the perception of performance. Interviews involved 7 Top Managers in charge of the 7 divisions of the Region and 15 Middle Managers in charge of departments. 17 focus groups involved 90 Middle Managers in charge of responsibility areas under each department.Results underline that Top Managers and Middle Managers are driven by different topoi and have a different concept of performance at the base of their efforts: Top Managers require flexibility and professionalisms in their work, while Middle Managers require precise plans and rules. The result is that different topoi have different concepts of performance and that the performance of the Regional Authority and the contribution of organizational actors to the achievement of organizational goals result unclear and confused. Findings underline that the alignment of topoi is of utmost importance to the design of an effective PMS in the organization: increasing the communication between these two organizational levels may favor the convergence of the two topoi and increase the clarity of the Regional Authority performance goals and measures

Cost Measurement in Laparoscopic Surgery: Results from an Activity-Based Costing Application

Activity Based Costing (ABC) techniques are designed to support advanced cost analysis in different organizations. Centred on organization activities and processes, it provides more accurate cost information on cost objects using appropriate cost drivers and constitutes a powerful costing model to improve efficiency and effectiveness in delivering products and services. ABC can be successfully appl ied also in Health Care organizations, where the patient is the main “object” of the activities performed. In addition, in can be fruitfully used in costing the resource consumption of new medical technology devices or surgery processes to assess their eco nomic impact on health care costs. The purpose of this paper is to describe an Activity based costing model designed to measure and control resources consumption and cost when a new technology is applied in health care processes. An ABC model has been defined in relation to laparoscopic technologies applied to surgical cases, designing a health care “activity hierarchy” based on the processes of a specific local unit organization. The output of the application has been a full cost of laparoscopic surgery to be compared with the correspondent DRG current value. As a further result, the paper shows how the ABC model is able to generate different cost figures referred to activity levels or aggregations able to support decision making especially when the introdu ction of a new surgical technology has to be economically assessed. Propositions are finally made to generate discussion about the effectiveness of the existing cost accounting systems in the health care organizations and on the need for the wider diffusio n of ABC techniques in this service sector

visual observations of floating macro litter around italy mediterranean sea

We report the results of a visual survey of floating natural (NML) and anthropogenic (AML) macro-litter (>2.5 cm) performed in the central part of the Mediterranean Sea during a dual-use campaign onboard the Italian Navy tall ship "Amerigo Vespucci" which circumnavigated the Italian peninsula during May-June 2016. The distribution, abundance and composition of floating marine litter were assessed using a 10 m fixed-width strip transect method. Over 88 h of transect counts were performed, for a total of 168 transects, covering an overall survey length of 1026.35 km. 4756 anthropogenic litter items were counted during the transects, 96.9 % of which were classified as plastic items. Floating litter was found throughout the entire study area with densities ranging from 0 to 9205 items/km2 and with a mean abundance of 492 AML items/km2 and 77 NML items/km2 across all surveyed locations. Maximum AML densities (>3500 items/km2) were recorded in the Adriatic Sea, while the lowest densities (<50 items/km2) were found along the coastline of Sardinia and in the Strait of Messina. Our results document the ubiquitous presence of floating plastic litter around the Italian peninsula and underline the need to expand our knowledge about the main sources, transport, accumulation and fate of marine litter in the entire Mediterranean region

Ambiguity in public sector performance measurement: a systematic literature review

Purpose – This paper presents a systematic literature review aiming at analysing how research has addressed performance measurement systems’ (PMSs) ambiguities in the public sector. This paper embraces the ambiguity perspective that PMSs in public sector coexist with and cope with existing ambiguities. Design/methodology/approach – The authors conducted a literature review in Scopus and ScienceDirect, considering articles published since 1985, and the authors selected articles published in the journals included in the Association of Business Schools’ Academic Journal Guide (Chartered ABS, 2018). Of the 1,278 abstracts that matched the study’s search criteria, the authors selected 131 articles for full reading and 37 articles for the final discussion. Findings – The study’s key findings concern the elements of ambiguity in PMSs discussed in the literature. The study’s results suggest that ambiguity is still a relevant problem in performance measurement, as a problem that is impossible to be solved and therefore needs to be better understood by researchers and public managers. The analysis allows us to summarize the antecedents and consequences of ambiguity in the public sector. Research limitations/implications – The key findings of the study concern the main sources of ambiguity in PMSs discussed in the literature, their antecedents and their consequences. The study results suggest that ambiguity exists in performance measurement and that is an issue to be handled with various strategies that can be implemented by managers and employees. Practical implications – Managers and researchers may benefit from this research as it may represent a guideline to understand ambiguities in their organizations or in field research. Researchers may also benefit from a summary list of the key issues that have been analysed in the empirical cases provided by this research. Social implications – This research may provide insights to limit ambiguity and thus contribute to improve performance measurement in the public sector. Originality/value – This research presents a comprehensive review on the topic. It provides insight that suggests what future research should attend to in helping to interpret ambiguity, considering also what should be done to influence ambiguity