ارزیابی تغییر سازمانی در بهداشت و درمان: مدل بیمارستان بیمارمحور Evaluating organizational change in health care: the patient-centered hospital model

Background In recent decades, national health care systems have been dealing with an increased demand for high-quality and patient-centered services, but limited resources have often challenged their sustainability ([1]). New demands and needs are emerging, connected with the growth of chronic pathologies, the ageing of the population, the development of technologies, the scarcity of economic resources and people’s emerging awareness of their care and cure rights. With respect to this demographic, epidemiological and social context, health care and hospital systems overall must innovate to respond to the new care needs. The mandate to “do more with less” encourages policy makers, health care managers and scholars to look for innovative ways to redesign health care services. The need for innovation is often interlaced with processes of organizational redesign in many forms. There are many examples of health care organizations that have committed to broad changes due to the actual social and economic demands. A significant stream of change relates to technological innovations, such as telemedicine ([2]). There exists extensive experience of activation of new social and integrated care networks. These are designed to act as community-based care networks ([3, 4]). A major movement in policy making identifies the “patientcentered approach” as the key leverage for making the health care delivery system respectful of, and responsive to, the current needs and requirements ([5–8]). The patient-centered approach, while presenting clear statements, principles of care and operative practices, also leads to different care model designs within hospitals ([9]). In fact, an increasing literature ([10–13]) suggests that innovation in health care should evolve towards a patient-centered (henceforth PC) model, reshaping hospitals with the aim of moving from functional towards process-oriented organizational forms, focusing on the process of care instead of on functional, self-referential departments within the hospital. To innovate towards the PC model, hospitals usually undergo a process of redesign that encompasses several restructuring actions, both in the organizational structure and in the physical building ([14]). Although the theoretical managerial literature on the PC model is vast, evaluations of the performance of hospitals that have moved from the functional to the PC organizational structure are scarce (with a few exceptions, such as [11, 15, 16]). The complexity of the variables at play, the sensitivity of data, which are not always made available for research, the diversity of the pathologies and types of patients and many other elements have so far made the construction of a methodological framework for the evaluation of the PC hospital model extremely challenging. The shift to different hospital models may therefore follow international trends and interests that not always are connect to clear ex ante impact evaluation ([17]). However, without any evaluative research, any innovation risks being perceived by local communities and by organizations’ employees as being driven more by political reasons or managerial trends than by a serious assessment of its benefits in terms of effectiveness and efficiency. In this work, we take the challenge to embark on a sound assessment of the efficiency and effectiveness of the PC model as opposed to the traditional functional-based hospital model.