Reframing Community Care Towards Proximity: A Strategy Map for Metropolitan Areas

Purpose – The purpose of this paper is to develop an integrative managerial framework supporting the operationalization of the proximity principle in community care, with a specific focus on metropolitan contexts. Design/methodology/approach – This study adopts a qualitative, interventionist research design conducted in four Italian metropolitan Local Health Units. Researchers facilitated structured processes of inter-organizational reflection and collective sensemaking involving top-level executives and their staff responsible for community care. Empirical material from organization-level workshops and cross-site plenary sessions was analysed through a cross-site comparative logic and inductively synthesized into a strategy map capturing recurrent organizational mechanisms underpinning proximity-oriented care. Findings – The study identifies a recurrent process logic through which proximity-oriented primary care is enacted in metropolitan settings. The findings are synthesized into a strategy map structured around three interrelated perspectives: a ‘community perspective’ addressing complex urban needs and multidimensional equity; an ‘internal processes and structures perspective’ describing the operational proximity pathway and its organizational supports; and an ‘innovation perspective’ highlighting the enabling and constraining role of organizational, informational, and professional capital. Overall, the results show that proximity does not rely on single organizational solutions, but on the coherent alignment of processes, structures, and resources within fragmented metropolitan care systems.[AC1.1] Originality - The paper offers one of the few empirical applications of strategy maps to the governance of community care in metropolitan settings. Through an interventionist approach, it moves beyond descriptive accounts by developing an analytically grounded framework that captures shared mechanisms and managerial trade-offs across organizations. It reframes proximity as a dynamic managerial process rather than as a set of predefined organizational models.