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Background Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption. Methods Qualitative study conducted as part of a series of randomized controlled trials of CDSSs. The sample includes two hospitals using a CDSS and two hospitals that aim to adopt a CDSS in the future. We interviewed physicians, nurses, information technology staff, and members of the boards of directors ( n  = 30). We used a constant comparative approach to develop a framework for guiding implementation. Results We identified six clusters of experiences of, and attitudes towards CDSSs, which we label as “positions.” The six positions represent a gradient of acquisition of control over CDSSs (from low to high) and are characterized by different types of barriers to CDSS uptake. The most severe barriers (prevalent in the first positions) include clinicians’ perception that the CDSSs may reduce their professional autonomy or may be used against them in the event of medical-legal controversies. Moving towards the last positions, these barriers are substituted by technical and usability problems related to the technology interface. When all barriers are overcome, CDSSs are perceived as a working tool at the service of its users, integrating clinicians’ reasoning and fostering organizational learning. Conclusions Barriers and facilitators to the use of CDSSs are dynamic and may exist prior to their introduction in clinical contexts; providing a static list of obstacles and facilitators, irrespective of the specific implementation phase and context, may not be sufficient or useful to facilitate uptake. Factors such as clinicians’ attitudes towards scientific evidences and guidelines, the quality of inter-disciplinary relationships, and an organizational ethos of transparency and accountability need to be considered when exploring the readiness of a hospital to adopt CDSSs.

Background An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. Methods We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the “between-variability” of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. Results We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. Conclusions Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both efficacy and efficiency. This evidence can be used to inform and sustain hospital managers and policy makers in their hospital design efforts and to communicate the innovation advantages within the hospital organizations, among the personnel and in the public debate.

Background: Ensuring the safety of patients in the operating room, through the monitoring and prevention of adverse events is a central priority of healthcare delivery. In the professionalization of operating room nurses, the processes of identifying, assessing, developing, monitoring, and certifying transversal competencies are crucial. While national and international frameworks have attempted to define such competencies, they often vary in scope and remain inconsistently integrated into education and clinical practice. There is, therefore, a need for a comprehensive and structured identification of transversal competencies relevant to both perioperative and perianesthesiological nursing roles. Objectives: To formulate a validated and structured repertoire of transversal competencies demonstrated by operating room nurses in both perioperative and perianesthesiological contexts. Methods: A qualitative descriptive design was adopted, combining shadowed observation with Hierarchical Task Analysis (HTA). A convenience sample of 46 participants was recruited from a university and a public hospital in Italy. Data were collected between September 2021 and June 2023 and analyzed using content analysis and data triangulation. Results: Through a qualitative, inductive and iterative approach the study identified 15 transversal competencies, 50 sub-competencies, and 153 specific tasks and activities. Specifically, operating room nurses working in perioperative and perianesthesiological roles presented the following transversal competencies: communication and interpersonal relationships, situation awareness, teamwork, problem solving and decision-making, self-awareness, coping with stressors, resilience and fatigue management, leadership, coping with emotions, task and time management, ethical and sustainable thinking, adaptation to the context, critical thinking, learning through experiences, and data, information and digital content management. Each competency was associated with specific tasks observed. Conclusions: This framework complements the existing repertoire of technical-specialist competencies by integrating essential transversal competencies. It serves as a valuable tool for the assessment, validation, and certification of competencies related to patient and professional safety, emotional well-being, relational dynamics, and social competencies. The findings underscore the need for academic institutions to revise traditional training models and embed transversal competencies in both undergraduate and postgraduate nursing education.

The concept of “patient centredness”, or “patient-centred care”, has been studied so far as an umbrella term including a variety of declinations, perspectives, and concrete care practices [...]

Purpose The study refers to a health-care organization engaged in adopting “home health care” as a new object of activity. This study aims to explore how the reconfiguration of the object influences the transformative perspective, affecting not just a service but a broader approach and meaning behind patient care. It also investigates the main contradictions at play and the levers to support inter-organizational learning while facing the new challenges and change processes. Design/methodology/approach The work is based on a qualitative and ethnographic methodology directed to examine cultural, practical and socio-material aspects. The activity theory is assumed as a powerful approach to understand collective learning and distributed agency processes. Findings The renewal of the new object of work is analyzed as a trigger for shifts in representations, cultural processes and collective support implemented by the organization. Three agentic trajectories – technical, dialogical and collaborative agency – were cultivated by the management to deliver home health care through joint exercises of coordination and control, dialogical spaces and collaborative process. Research limitations/implications The data collection was disrupted by the pandemic. A follow-up study would be beneficial to inquire how the learning processes shifted or were influenced by the contextual changes. Practical implications This contribution provides a practical framework for health-care organizations aiming to navigate and explore the physiological tensions and contradictions emerging when the object of work is changed. Originality/value The paper develops the field of intra- and inter-organizational learning by presenting an intertwined and structural connection between these processes and the renewing of the object of work. It advises that processes of transformation must be handled with attention to the critical and collective dynamics that accompany sustainable and situated changes.

[...]the past two decades have seen a rapid accumulation of research in the management and related literatures on job mobility, that is, the movement of individuals between jobs, organisations or types of work.1 This research has primarily been situated in for-profit business firms, but the questions, methods of inquiry and findings could apply more broadly, specifically, to healthcare contexts. [...]we briefly consider implications on healthcare research and policy. [...]recent research has shown how individuals balance internal and external job mobility in their careers, showing how internal mobility is more strongly associated with upward progression and expanded responsibilities, while external movement is associated with increased pay.19 The processes that organisations use to hire internally—the way that over half of positions are still filled—also influence employability. Innovation relies on the recombination of diverse knowledge,26 and incoming workers can be a source of new useful knowledge.27 Researchers have demonstrated an interorganisational learning effect, showing that firms can use hiring to learn from other firms by hiring their employees. Because hiring is a relatively effective way of acquiring complex knowledge, it is especially useful for learning from geographically or technologically distant organisations,28 or when organisations need to update their capabilities.29 Top manager mobility can have even broader reaching effects, as top managers can bring strategic priorities based on their prior experience that can lead their new firms to enter new business areas.30 31 Career background also conditions which external information is attended to and which other organisations are considered to be peers.32 Mobility across industries or sectors can lead to broader institutional change.

Background: Well-being at school is a recurrent hot topic within the educational field as a crucial issue for societies. Teachers often face tension with pupils and colleagues. Well-being is very often considered an individual achievement requiring individual measurement and support. This paper, in contrast, applies an approach that supports an ecological perspective of school well-being, implying a complex and multi-dimensional development investment. Methods: The paper investigates an innovative program initiative aimed at providing support to 50 Italian schools that have been deemed as critical for specific aspects (pupils’ levels of learning, discomfort among teachers, scarce innovativeness, etc.) through evaluative qualitative research. Results: This work sheds light on well-being as a dynamic construct created through an integrative effort in which many factors can play a role. These factors are the possibility of professional tutoring to help engage the school management and involve teachers in a bottom-up involvement, the development of creative initiatives and innovative projects to respond to context-based challenges and pupils’ needs, and the availability of space and time for collective sharing of ideas among teachers. These processes are closely related to the concept of well-being, which appears to be a systemic construct, rather than an issue related to the single individual. Conclusions: Focusing on the representation of schools’ managers and tutors involved in the program, this research illustrates the application of an ecological perspective that creates well-being through social and productive sustainability processes.