Chronic disease management in Lombardy Region: the challenge to co-opt physician and involve other operators on a network perspective

Chronic diseases are becoming an important issue in our society as result of the aging population. The future demand for this kind of health services will increase dramatically; many researchers suggests that diabetes illness is strongly spreading like an epidemic as a consequence of the increasing overweight and obesity in the population. On the other hand NHS (National Health Service in Italy is called SSN) is looking for more efficiency due to the cut in the budget related to the welfare state crisis. According to this trends, in the spring of 2011, the Lombardy Region has launched a new project aiming at re-engineering the service provided in the territory to this specific chronic patients with the goal to save resources and improve citizen satisfaction by outsourcing the care process service to a central providers instead of having many non-coordinated operators acting individually. General practitioners (GP) have been co-opted by RHS (Regional Health Service) to become the “control room” and to create a network of collaboration composed by heterogeneous operators and professionals in order to respond to those healthcare needs. GPs have aggregated into groups to govern the provider operational networks and are now approaching and learning the way to manage and face the intrinsic dualities between change (the new health configuration system) and stability (coerce vs concede, confront vs conform, create vs consolidate) (Ritter and Ford, 2004). This paper is devoted to the evolution in the approach of chronic illness management and thus is aimed to investigate the challenge to administer the service to the citizen by a centralized network of physicians who act as general providers and who have to involve other health operators as operational and specific providers (nurses, specialists, pharmacists, etc.). Based on the emerging theories on network relationship constructs, as stated by the IMP Group school, this work in progress paper wants to explore the deep nature of relationship among actors, the resources needed to deploy the new service model, the actor willingness to invest in a common setting and finally the activities and processes that should be established to assure a qualified service and the patient satisfaction. As the Lombardy’s region project is in his pilot phase during all 2012 year long, the paper will report the synthesis of interviews held with the project leaders. The object of this first investigation is related to the design phase of the project and a first evaluation of the pilot phase outcome. In particular research questions pertains to some aspects such as: can it be effective to move from a general constellation of independent operators to a network focused on a pivotal provider responsible for anything? Can GPs aggregations will manage this kind of complexity evolving from a professional status to an entrepreneurial one? Can an existing service network be changed radically by an actor pressure? Can the evolution of a network be forced as regards time constraint or has its own natural rhythm? From a methodological point of view, the investigation of the aforementioned issues and research questions are based both on some interviews made to operators and on the analysis of the information reported on newspapers, websites and other available public information systems. The framework used to deploy this first understanding of the project is based on the ARA (Actors, Resources and Activities) model IMP approach . This descriptive and qualitative analysis will be the basis to a wider quantitative research aiming at assessing the framework of the new model and outcome.