Framing doctor-managers' resilience during Covid-19 pandemic: A descriptive analysis from the Italian NHS.

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era.

Exploration of the mediating role of physicians' managerial attitude in the relationship between their self-efficacy and workplace performance.

PURPOSE: Self-efficacy, or a person's belief in his/her ability to perform specific tasks, has been correlated with workplace performance and role adjustments. Despite its relevance, and numerous studies of it in the management literature, evidence regarding its function in professionals employed in hybrid roles, such as doctor-managers, is lacking. The aim of this study was to fill this gap by exploring the mediating effect of physicians' managerial attitude on the relationship between their self-efficacy and workplace performance. DESIGN/METHODOLOGY/APPROACH: Primary and secondary data from 126 doctor-managers were obtained from the Italian National Health Service. A structural equation modeling approach was used for analysis. FINDINGS: This study's results provide for the first time empirical evidence about a surprisingly little-analyzed topic: how physicians' managerial attitude mediates the relationship between their self-efficacy and workplace performance. The study offers important evidence both for scholars and organizations. PRACTICAL IMPLICATIONS: This study's results provide valuable input for the human resources management of hybrid roles in professional-based organizations, suggesting a systematic provision of feedback about doctor-managers' performance, the adoption of a competence approach for their recruitment, and a new design of doctor-managers' career paths. ORIGINALITY/VALUE: The authors provide new evidence about the importance of managerial traits for accountable healthcare organizations, documenting that behavioral traits of physicians enrolled into managerial roles matter for healthcare organizations success.

The microfoundations of physicians' managerial attitude.

BACKGROUND: Accountable care has profoundly changed the organizational models adopted by health care organizations and, consequently, the skill set required for doctor-managers who have become middle managers and must deal with the operational management of their units. The aim of this study was to identify the psychological microfoundations (i.e., traits) of physicians' managerial attitude. Specifically, we analysed the roles played by narcissism, specialization choices and identification with the organization. METHODS: We collected primary data on a population of ward unit heads in the Italian National Health Service. A logistic regression model predicting the levels of managerial attitude was employed. RESULTS: The results indicate that high levels of narcissism and identification with the organization are related to higher managerial attitude (instead of clinical attitude). Additionally, we found that physicians with a technique-oriented specialization present a higher probability of manifesting managerial attitude (in comparison to clinical attitude). CONCLUSIONS: Hospital managers can benefit from the use of these findings by developing a strategic approach to human resource management that allows them to identify, train and select the right mix of technical knowledge and managerial skills for middle-management roles.

Individual and job-related determinants of bias in performance appraisal: The case of middle management in health care organizations.

BACKGROUND: Accountable care has changed organizational models adopted by health care organizations profoundly and, consequently, the skill set required for doctor-managers who have become middle managers and must deal with the operational management of their units. Doctor-managers must carry out clinical tasks as well as tasks related to budgeting, goal setting, and performance evaluation. The performance evaluation bias, defined as the misalignment between a ward unit's objective performance (as assessed by technical bodies or agencies) and self-assessed performance by the head of the unit, may have serious consequences for individuals and organizations. PURPOSE: The aim of this study was to identify determinants of performance appraisal bias based on the mismatch between self-reported and official performance data. Specifically, we analyzed the role played by managerial behavior, training, engagement, and perceived organizational support at the individual level, as well as the particular unit's task diversity, complexity, and predictability. METHODOLOGY: We collected primary and secondary data referable to a population of ward unit heads in the Italian National Health Service. A linear regression model predicting performance appraisal bias was employed. FINDINGS: High levels of engagement and perceived organizational support were associated with reduced performance appraisal bias, whereas high levels of predictability and task diversity were associated with increased degree of error. Doctor-managers attending training programs in health care management and ward unit task complexity did not affect bias significantly. PRACTICE IMPLICATIONS: Policy makers and hospital managers should provide heads of units with tools that enable them to conduct ongoing monitoring and accurate appraisal of performance. Doctor-manager performance appraisal bias may be diminished by a perception of having support of the organization and direct superiors. Training programs can be revised to incorporate performance appraisal, and good performance may be incentivized with rewards.

A bibliometric and network analysis of Lean and Clean(er) production research (1990/2017).

In recent years, the renewed interest in environmental issues has gradually required manufacturers to simultaneously pursue a more rational use of resources and a reduction in wastes production. New strategies, technologies and organisational innovations must be therefore conceived to "create more value with less impact" (WBCSD, 2010). An interesting and promising perspective for achieving internal efficiency, market effectiveness and environmental eco-efficiency is that of integrating the environmental variable in the Lean Production (LP) paradigm. Scholars and practitioners have been working for some years in this direction of eco-innovation. The present article aims at obtaining a quali/quantitative overview of Lean and Clean(er) production (L&C) research through a bibliometric and network analysis, by using a scientific literature database; in particular, it investigates how Clean(er) Production research and publications are progressively embedded in the field of LP, what are the main topics in this sub-field and common research themes. A comprehensive picture was made by analysing data concerning publications, authors, affiliations, and the countries of origin. Evolutionary profiles, major topics investigated, leading authors and collaborations have been reported. The results also reveal promising spaces for the development of L&C production research, in order to achieve economic and environmental benefits.

Exploring the networking behaviors of hospital organizations.

BACKGROUND: Despite an extensive body of knowledge exists on network outcomes and on how hospital network structures may contribute to the creation of outcomes at different levels of analysis, less attention has been paid to understanding how and why hospital organizational networks evolve and change. The aim of this paper is to study the dynamics of networking behaviors of hospital organizations. METHODS: Stochastic actor-based model for network dynamics was used to quantitatively examine data covering six-years of patient transfer relations among 35 hospital organizations. Specifically, the study investigated about determinants of patient transfer evolution modeling partner selection choice as a combination of multiple organizational attributes and endogenous network-based processes. RESULTS: The results indicate that having overlapping specialties and treating patients with the same case-mix decrease the likelihood of observing network ties between hospitals. Also, results revealed as geographical proximity and membership of the same LHA have a positive impact on the networking behavior of hospitals organizations, there is a propensity in the network to choose larger hospitals as partners, and to transfer patients between hospitals facing similar levels of operational uncertainty. CONCLUSIONS: Organizational attributes (overlapping specialties and case-mix), institutional factors (LHA), and geographical proximity matter in the formation and shaping of hospital networks over time. Managers can benefit from the use of these findings by clearly identifying the role and strategic positioning of their hospital with respect to the entire network. Social network analysis can yield novel information and also aid policy makers in the formation of interventions, encouraging alliances among providers as well as planning health system restructuring.

Unfolding similarity in interphysician networks: the impact of institutional and professional homophily.

BACKGROUND: Modern healthcare is characterized by high complexity due to the proliferation of specialties, professional roles, and priorities within organizations. To perform clinical interventions, knowledge distributed across units, directorates and individuals needs to be integrated. Formal and/or informal mechanisms may be used to coordinate knowledge and tasks within organizations. Although the literature has recently considered the role of physicians' professional networks in the diffusion of knowledge, several concerns remain about the mechanisms through which these networks emerge within healthcare organizations. The aim of the present paper is to explore the impact of institutional and professional homophilies on the formation of interphysician professional networks. METHODS: We collected data on a community of around 300 physicians working at a local health authority within the Italian National Health Service. We employed multiple regression quadratic assignment procedures to explore the extent to which institutional and professional homophilies influence the formation of interphysician networks. RESULTS: We found that both institutional and professional homophilies matter in explaining interphysician networks. Physicians who had similar fields of interest or belonged to the same organizational structure were more likely to establish professional relationships. In addition, professional homophily was more relevant than institutional affiliation in explaining collaborative ties. CONCLUSIONS: Our findings have organizational implications and provide useful information for managers who are responsible for undertaking organizational restructuring. Healthcare executives and administrators may want to consider the structure of advice networks while adopting new organizational structures.

Effect of hospital referral networks on patient readmissions.

Previous studies have shown that referral networks encompass important mechanisms of coordination and integration among hospitals, which enhance numerous organizational-level benefits, such as productivity, efficiency, and quality of care. The present study advances previous research by demonstrating how hospital referral networks influence patient readmissions. Data include 360,697 hospitalization events within a regional community of hospitals in the Italian National Health Service. Multilevel hierarchical regression analysis tests the impacts of referral networks' structural characteristics on patient hospital readmissions. The results demonstrate that organizational centrality in the overall referral network and ego-network density have opposing effects on the likelihood of readmission events within hospitals; greater centrality is negatively associated with readmissions, whereas greater ego-network density increases the likelihood of readmission events. Our findings support the (re)organization of healthcare systems and provide important indications for policymakers and practitioners.

Professional networks and EBM use: a study of inter-physician interaction across levels of care.

Physicians around the globe are increasingly encouraged to adopt guidelines, protocols and other scientific material when making clinical decisions. Extant research suggests that the clinicians' propensity to use evidence-based medicine (EBM) is strongly associated with the professional collaborative networks they establish and maintain with peers. In this paper we explore whether and how the connectedness of primary care physicians with colleagues working in hospital settings is related to their frequency of EBM use in clinical practice. We used survey data from 104 pediatricians working in five local health authorities in the Italian NHS. Social network and attributional data concerning single physicians, as well as their self-reported frequency of EBM use, were collected for three major pathologies in pediatric care: asthmatic, gastro-enteric and urinary pathologies. Ordered regression analysis was employed. Our findings documented a positive association between the number of physicians' relationships with hospital colleagues and the frequency of use EBM. Results also indicated that physicians' organizational affiliations influence the frequency of EBM use. Finally, contrary to our expectations, it was found that clinicians' affiliation to formal collaborative arrangements is at odds with the likelihood of reporting higher frequency of EBM use.

Dynamics of hospital competition: social network analysis in the Italian National Health Service.

BACKGROUND: In the early 1990s, the governments of many countries took the first steps toward introducing market forces into the provision of health care services, with the aim of increasing hospital efficiency and quality of care. Several reforms have been developed to strengthen the role of competition, giving rise to forms of "managed competition." As a result, the environment in which providers operate and perform is increasingly characterized by conditions of competition, rather than of cooperation. PURPOSE: The aim of this study was to analyze the evolution of competitive interdependences among hospitals and the impact of organizational demographics on pair-wise competition. METHODOLOGY: Longitudinal data on competitive interdependences collected within a regional community of hospital organizations in the Italian National Health Service were analyzed. Stochastic actor-based models designed for estimating network dynamics were used to study organizational characteristics influencing patterns of change in competitive interdependences. FINDINGS: The results indicated that interorganizational cooperation is a significant predictor of competitive interdependences, that pair-wise competition among hospitals is primarily local, and that competitive interdependences are more likely to occur between local providers that differed with respect to performance and volume of activity. PRACTICE IMPLICATIONS: Exploring the evolution of competitive interdependences between hospitals is salient for administrators who are interested in increasing their understanding of the whole market. They can better identify direct competitors by paying particular attention to those organizational characteristics that likely predict competitive actions. This approach is also important for policy makers, which may be interested in better targeting hospital restructuring interventions while implementing procompetition reforms.

Dynamic analysis of interhospital collaboration and competition: empirical evidence from an Italian regional health system.

BACKGROUND: Policymakers stimulate competition in universalistic health-care systems while encouraging the formation of service provision networks among hospital organizations. This article addresses a gap in the extant literature by empirically analyzing simultaneous collaboration and competition between hospitals within the Italian National Health Service, where important procompetition reforms have been implemented. PURPOSE: To explore how rising competition between hospitals relates to their propensity to collaborate with other local providers. METHODS: Longitudinal data on interhospital collaboration and competition collected in an Italian region from 2003 to 2007 are analyzed. Social network analysis techniques are applied to study the structure and dynamics of interhospital collaboration. Negative binomial regressions are employed to explore how interhospital competition relates to the collaborative network over time. RESULTS: Competition among providers does not hinder interhospital collaboration. Collaboration is primarily local, with resource complementarity and differentials in the volume of activity and hospital performance explaining the propensity to collaborate. CONCLUSIONS: Formation of collaborative networks among hospitals is not hampered by reforms aimed at fostering market forces. Because procompetition reforms elicit peculiar forms of managed competition in universalistic health systems, studies are needed to clarify whether the positive association between interhospital competition and collaboration can be generalized to other health-care settings.

Understanding hospital performance: the role of network ties and patterns of competition.

BACKGROUND: To improve efficiency and quality, a number of policies have recently been implemented to increase competition and cooperation within the health systems of many countries. We theorize how hospital performance, measured as productivity, is contingent upon network embeddedness, the extent to which a hospital is involved in a network of interconnected interorganizational relationships. PURPOSE: The aim of this study was to explore the effects on hospital productivity resulting from both collaborative network ties and competitive relationships between providers. METHODOLOGY: We used panel data collected between 2003 and 2007 from 35 hospitals in Abruzzo, one of the most populated regions of central Italy. We used secondary data of hospital activities regarding both clinical and administrative aspects. For each year, we examined the intensity of interhospital competition and the unique position each provider has within a larger network of relationships with other hospitals. Other idiosyncratic organizational characteristics were examined as well. FINDINGS: Our results show that hospital productivity is negatively related to the degree of competition that a hospital faces and positively related to the degree with which hospitals establish collaborative relationships. We also found that the negative impact on hospital productivity due to competition was lessened when hospitals were more likely to create cooperative network ties. PRACTICE IMPLICATIONS: Because interhospital collaboration and competition are related to hospital productivity, they should constitute a core element in the strategic planning of a hospital's operation. Health administrators should implement policies that favor collaborative network ties at the regional level and mitigate interorganizational rivalries when establishing collaborative relationships with local competitors.