Chronic disease management in the Lombardy region: An evolutionary service network perspective

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The Italian SMEs in the International context. A model to succeed in the global arena

� This paper explores the internationalization process of the Italian SMEs, and aims to investigate their behaviour in the international contexts to ultimately outline general models able to optimize their peculiarities. The empirical study firstly examines 546 SMEs along their internationalization. The internationalization process is examined through its phases: decisions, marketing strategy, achievements and future perspectives. A second aim is to define sustainable paths for SMEs willing to expand successfully over the Country borders. It also proposes important issues and management implications to be considered in the international development of Italian SMEs.

Mapping Protein Structure Changes with Cysteine Labeling Kinetics by Mass Spectrometry

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide "system" inertia-really difficult to be overcome-and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of "fertilizing a patient engagement ecosystem": an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient "disengagement" is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper

Acute Pain Service, un nuovo servizio nell\u2019esperienza dell\u2019Humanitas Mater Domini. Gestire il dolore e ascoltare il paziente per un outcome di qualit\ue0

Although quality has long been debated in service industry starting from different models developed with respect to goods, there is still room for further investigation on service quality, especially on the definition and the identification of the dimensions of it through performance indicators, the development of tools for measuring it and the analysis of customer satisfaction as a criterion for evaluation. Service quality is also particularly important in fast changing environments. In this type of context it becomes, both, a necessity and a strategic asset for the development of the business. Moving from this stance, the health sector, due to the process of corporatization and the growing interdependence of actors interaction within the system, is gradually reshaping in terms of quality with a more and more patient-oriented perspective: The quality of the service, the effectiveness of nursing care services (i.e. the technical quality of the performance) can no more be detached from customer/patient satisfaction assessment (or functional/relational quality). Through the analysis of Humanitas Mater Domini Hospital (Castellanza, Italy), as a specific case study, and the introduction of a new service offered to patients (APS, Acute Pain Service), the aim of the study is to investigate how health care services can respond to the changes taking place within the system, to highlight possible ways in which the issues of service quality and patient satisfaction are pursued within the context of health care sector and how they can impact on the care processes within the syste

Processi di internazionalizzazione delle pmi e dinamiche culturali

Among the many researches related to internationalisation and international development, few contributes are really designed to suit small and medium enterprises\u2019 specific needs. This paper explores the internationalisation process of the textile-clothing Italian small and medium enterprises, and aims to investigate their behavior in the international contexts and the impact on the internationalization process to ultimately outline their profile in the international arena and general guidelines able to optimize their peculiarities. The empirical study firstly examines 159 SMEs along their internationalisation process and in a second step, still ongoing, will focus on selected enterprises (the best practices) in order to extract with in depth personal interviews major outcomes about the impact of cultural dimensions. The internationalisation process is examined through its phases, in particular the decision phase \u2013 motivation to expand abroad and introductory activities - the international marketing strategy \u2013 marketing mix and operative instruments - the achievements and future perspectives. The final aim is to define sustainable paths for SMEs willing to expand successfully over the Country borders

Elderly and Health Care services: the elements characterising the patient satisfaction

Recent transformations in the policies of the health system (crisis of the welfare state, administrative decentralization, corporatization, etc..) modified the traditional relationships between health services and citizens-patients. The supply of health services, in fact, is now increasingly constrained by the citizens-patients\u2019 needs and their related opinion on satisfaction. Research on service quality and customer satisfaction become, then, a needful business tool in planning health care services. In this sense, especially in this context characterized by information asymmetry, health system priorities become quality, efficiency, care suitability and customised medical supply. The purpose of this paper is thus to identify which elements characterise citizens-patients satisfaction and how these elements are influenced by hard (medical competencies, continuity) or soft (relational, hospitality) factors. As methodology a structured equation modelling has been applied. As a result of a structured questionnaire - designed to assess satisfaction items and its antecedents on a 1 to 7 Likert scale - 450 cases resulted eligible to be submitted to the statistical analysis. This method, in fact, allowed us to study simultaneously the structure of the interconnections between observed explanatory variables, latent factors (summary of individual aspects of assessment) and overall degree of citizens-patients satisfaction. The output of this exploratory analysis underlined soft elements as the most statistically relevant factors explaining citizens-patients satisfaction compared to the hard ones

The Web Strategy development in the automotive sector

The Web is a lever at the disposal of management to pursue and implement the business strategy. Especially in recent years, indeed, a transformation is ongoing: the Web, besides being a means of information sharing (internal-external), becomes a powerful tool for saving costs, reduce the distribution structure, initiate distance transactions and ever more becomes a mechanism of integration with the external environment and a catalyst of experiences for all stakeholdes. Starting from the identification of the key elements, potentialities and of the impact of Internet on firms\u2019 performance, competitiveness, effectiveness and efficiency, this chapter is focused on the changes in the automotive sector due to the integration between business strategy and web strategy. Therefore, starting from the consideration of a clear identification and subsequent sharing need of strategic goals, a research work will be presented exploring, on the basis of an interpretative model, the Internet potential in the automotive sector, in order to achieve the identification of an optimal path definition and development of Web Strategy. This objective will be developed in two stages. The first one: a desk analysis focused on the strategic positioning of the current businesses in the automotive sector (complexity evaluation of the presence on Internet, strategic architecture, quality and effectiveness of the presence). The second one: a path definition of optimal development of Web Strategy in automotive sector, using the experience of a best practice such as FIAT (sharing with the corporate managers the paths for preparation, definition and subsequent deployment of Web Strategy, critical aspects in development time, the expectations and needs of people directly or indirectly involved)

Chronic disease management in Lombardy Region: the challenge to co-opt physician and involve other operators on a network perspective

Chronic diseases are becoming an important issue in our society as result of the aging population. The future demand for this kind of health services will increase dramatically; many researchers suggests that diabetes illness is strongly spreading like an epidemic as a consequence of the increasing overweight and obesity in the population. On the other hand NHS (National Health Service in Italy is called SSN) is looking for more efficiency due to the cut in the budget related to the welfare state crisis. According to this trends, in the spring of 2011, the Lombardy Region has launched a new project aiming at re-engineering the service provided in the territory to this specific chronic patients with the goal to save resources and improve citizen satisfaction by outsourcing the care process service to a central providers instead of having many non-coordinated operators acting individually. General practitioners (GP) have been co-opted by RHS (Regional Health Service) to become the \u201ccontrol room\u201d and to create a network of collaboration composed by heterogeneous operators and professionals in order to respond to those healthcare needs. GPs have aggregated into groups to govern the provider operational networks and are now approaching and learning the way to manage and face the intrinsic dualities between change (the new health configuration system) and stability (coerce vs concede, confront vs conform, create vs consolidate) (Ritter and Ford, 2004). This paper is devoted to the evolution in the approach of chronic illness management and thus is aimed to investigate the challenge to administer the service to the citizen by a centralized network of physicians who act as general providers and who have to involve other health operators as operational and specific providers (nurses, specialists, pharmacists, etc.). Based on the emerging theories on network relationship constructs, as stated by the IMP Group school, this work in progress paper wants to explore the deep nature of relationship among actors, the resources needed to deploy the new service model, the actor willingness to invest in a common setting and finally the activities and processes that should be established to assure a qualified service and the patient satisfaction. As the Lombardy\u2019s region project is in his pilot phase during all 2012 year long, the paper will report the synthesis of interviews held with the project leaders. The object of this first investigation is related to the design phase of the project and a first evaluation of the pilot phase outcome. In particular research questions pertains to some aspects such as: can it be effective to move from a general constellation of independent operators to a network focused on a pivotal provider responsible for anything? Can GPs aggregations will manage this kind of complexity evolving from a professional status to an entrepreneurial one? Can an existing service network be changed radically by an actor pressure? Can the evolution of a network be forced as regards time constraint or has its own natural rhythm? From a methodological point of view, the investigation of the aforementioned issues and research questions are based both on some interviews made to operators and on the analysis of the information reported on newspapers, websites and other available public information systems. The framework used to deploy this first understanding of the project is based on the ARA (Actors, Resources and Activities) model IMP approach . This descriptive and qualitative analysis will be the basis to a wider quantitative research aiming at assessing the framework of the new model and outcome

La sfida della qualit\ue0 nell\u2019economia dell\u2019immateriale

Da tempo la qualit\ue0 \ue8 area d\u2019interesse da parte di ricercatori e manager. Essa \ue8 stata definita e declinata in una pluralit\ue0 di modi e interpretazioni differenti, considerandone l\u2019impatto sia sulle performance interne in termini di driver dell\u2019efficienza interna, sia quale elemento a supporto di una migliore efficacia esterna, verso il mercato. Per tali motivi la ricerca di definizioni, modelli, misure, ricerche, analisi dati etc. ha sviluppato una consistente base di studio da adattare e applicare ai diversi contesti nei quali la qualit\ue0 si esplicita. E parlando di contesti in cui il tema della qualit\ue0 \ue8 stato indagato il settore dei servizi non fa eccezione. La crescente attenzione verso un modello sistemico nella definizione di qualit\ue0 ha portato a delineare delle dimensioni ulteriori del costrutto andando verso tematiche di innovazione, risultato e processo. Infatti, la ricerca della qualit\ue0 \ue8 sempre stata una componente strategica per qualsiasi impresa appartenente ai diversi contesti per avere successo e sopravvivere in ambienti a crescente pressione competitiva quali quelli dei giorni nostri. \uc8 per tale motivo che lo sviluppo del concetto della qualit\ue0 non pu\uf2 essere slegato da una analisi di scenario, legata allo sviluppo di settori e mercati e contesti competitivi

The company as an integrated marketing system: a shared approach of knowledge, competences and goals

Among the moments characterizing firms\u2019 activities we can mention marketing planning and organization, together with knowledge sharing (knowledge transfer), which represent complicated issues and worthy topics. In a firm, the term \u2018organization\u2019 is often considered a mere synonymous of duty and business assigned to the workers.This view has then generated a \u201chermetical compartment approach\u201d in corporate management, without energizing strategies, ideas or information sharing. A wider angle and interesting view (of organisational concept) allows the integration of not only operational but also strategic dimensions. Process thinking means to consider the company as an integrated system of knowledge, competencies (at any structural level), considering (corporate) actions cohesive and coordinated towards a common business goal. A basic hypothesis of this paper relies on the consideration that the organizational structure doesn\u2019t take care of the knowledge impact and the information transfer on corporate performance. The objective of the present paper is therefore a company rethinking according to a logic of efficiency and optimisation of its organisational structure. The authors will take inspiration from the sailing world, in which strategies for sharing value and information melt in group dynamics considered effective and efficient means able to yield higher performance and exiting individualistic logics