TY - JOUR
T1 - Reorganising hospitals to implement a patient-centered model of care: Effects on clinical practice and professional relationships in the Italian NHS
AU - Liberati, Elisa Giulia
AU - Gorli, Mara
AU - Scaratti, Giuseppe
PY - 2015
Y1 - 2015
N2 - Purpose – The purpose of this paper is to understand how the introduction of a patient-centered
model (PCM) in Italian hospitals affects the pre-existent configuration of clinical work and interacts
with established intra/inter-professional relationships.
Design/methodology/approach – Qualitative multi-phase study based on three main sources:
health policy analysis, an exploratory interview study with senior managers of eight Italian hospitals
implementing the PCM, and an in-depth case study that involved managerial and clinical staff of one
Italian hospital implementing the PCM.
Findings – The introduction of the PCM challenges clinical work and professional relationships, but
such challenges are interpreted differently by the organisational actors involved, thus giving rise to
two different “narratives of change”. The “political narrative” (the views conveyed by formal policies
and senior managers) focuses on the power shifts and conflict between nurses and doctors, while the
“workplace narrative” (the experiences of frontline clinicians) emphasises the problems linked to the
disruption of previous discipline-based inter-professional groups.
Practical implications – Medical disciplines, rather than professional groupings, are the main source
of identification of doctors and nurses, and represent a crucial aspect of clinicians’ professional identity.
Although the need for collaboration among medical disciplines is acknowledged, creating multidisciplinary
groups in practice requires the sustaining of new aggregators and binding forces.
Originality/value – This study suggests further acknowledgment of the inherent complexity of
the political and workplace narratives of change rather than interpreting them as the signal of
irreconcilable perspectives between managers and clinicians. By addressing the specific issues regarding
which the political and workplace narratives clash, relationship of trust may be developed through which
problems can be identified, mutually acknowledged, articulated, and solved.
AB - Purpose – The purpose of this paper is to understand how the introduction of a patient-centered
model (PCM) in Italian hospitals affects the pre-existent configuration of clinical work and interacts
with established intra/inter-professional relationships.
Design/methodology/approach – Qualitative multi-phase study based on three main sources:
health policy analysis, an exploratory interview study with senior managers of eight Italian hospitals
implementing the PCM, and an in-depth case study that involved managerial and clinical staff of one
Italian hospital implementing the PCM.
Findings – The introduction of the PCM challenges clinical work and professional relationships, but
such challenges are interpreted differently by the organisational actors involved, thus giving rise to
two different “narratives of change”. The “political narrative” (the views conveyed by formal policies
and senior managers) focuses on the power shifts and conflict between nurses and doctors, while the
“workplace narrative” (the experiences of frontline clinicians) emphasises the problems linked to the
disruption of previous discipline-based inter-professional groups.
Practical implications – Medical disciplines, rather than professional groupings, are the main source
of identification of doctors and nurses, and represent a crucial aspect of clinicians’ professional identity.
Although the need for collaboration among medical disciplines is acknowledged, creating multidisciplinary
groups in practice requires the sustaining of new aggregators and binding forces.
Originality/value – This study suggests further acknowledgment of the inherent complexity of
the political and workplace narratives of change rather than interpreting them as the signal of
irreconcilable perspectives between managers and clinicians. By addressing the specific issues regarding
which the political and workplace narratives clash, relationship of trust may be developed through which
problems can be identified, mutually acknowledged, articulated, and solved.
KW - Hospitals
KW - Medical professions
KW - Organisational innovation
KW - Patient-centered care
KW - Roles
KW - Hospitals
KW - Medical professions
KW - Organisational innovation
KW - Patient-centered care
KW - Roles
UR - http://hdl.handle.net/10807/79505
UR - http://www.emeraldinsight.com/doi/full/10.1108/jhom-07-2014-0129
U2 - 10.1108/JHOM-07-2014-0129
DO - 10.1108/JHOM-07-2014-0129
M3 - Article
SN - 1477-7266
VL - 29
SP - 848
EP - 873
JO - JOURNAL OF HEALTH ORGANISATION & MANAGEMENT
JF - JOURNAL OF HEALTH ORGANISATION & MANAGEMENT
ER -