Aprire la black box dell'innovazione organizzativa: l'Intensità di Cura in pratica

Innovating toward a patient centred\r\n(PC) model presents great potentialities\r\nfor the improvement of the health care\r\ndelivery system, but, at the same time, it\r\nchallenges hospitals’ pre-existing organizational\r\nand professional structure. This\r\nstudy examines the social processes that\r\nunderpin and shape the PC innovation\r\nduring its actual implementation, so far\r\npoorly explored by the literature.\r\nGrounded in the findings of an ethnographic\r\nresearch, the study shows that\r\nthe PC innovation is not merely a process\r\nof adaptation, but rather consists in a\r\ncomplex interaction between a new formal model and the informal social organization\r\nof the hospital (e.g. hierarchies,\r\nbehavioural norms, jargon in use, implicit\r\nrules for balancing autonomy and\r\npower). This interaction gives rise to\r\ndesired outcomes but also to unexpected\r\neffects. For example, the creation of new\r\nteams and care settings may lead to the\r\nrenegotiation of the implicit agreements\r\nconcerning nurses’ autonomy and jurisdiction,\r\nthus affecting the integration and\r\nquality of the delivered care. The contribution\r\nprovides an in-depth exploration\r\nof these processes and offers some suggestions\r\nto decision makers and managers\r\naimed at bridging the gap between the\r\ninnovation formal program and daily\r\ncare practices, thus fully exploiting the\r\npotentiality of the innovation.