Organizational innovation in the Italian health care context: reconfiguring work practices and relationships in Care Focused hospitals

In the last decade, several Italian hospitals started looking with interest to a new organizational paradigm, labeled Care Focused (henceforth CF), that borrows design principles from those above (Lega and DePietro, 2005; Villa, Barbieri, and Lega, 2009). Lega and DePietro (2005) extensive review on the major converging trends of reorganizations suggests that hospital are evolving towards a CF model, moving from functional towards process-oriented organizational forms, namely focusing on the process of care instead of on functional departments based on medical specialties. The two main drivers for innovating toward a CF model are: the need to reduce waste hence increase hospital efficiency; the need to reshape care delivery processes around the needs of patients and increase the effectiveness of the treatment (Villa et al., 2009; Walston and Kimberley, 1997).As for many lean-oriented and patient centered innovation in health care, changing towards CF hospitals does not come without contradictions with preexisting practices and trends (Bromley, 2012; Mikesell and Bromley (2012). Translating policies into local practice is an arduous challenge, especially when the structural and process-related changes have the potential to affect existing working relations, practices, power dynamics and jurisdictions. Therefore, the translation of the CF design in the actual hospital organizations is likely far from straightforward. Our paper investigates the implementation of the CF model within the Italian National Health Service, to understand whether and how this particular management and organizational approach interacts and transforms established ways of working and affects the social organization of health care. Specifically, we address the effects of the CF innovation on pre-existing working practices and professional relationships, and reflect on the inherent challenges of translating new organizational designs into practice by integrating them in local contexts. We develop our analysis drawing upon the ‘technologies-in-practice’ approach (Timmermans & Berg, 2003) which considers how technologies such as the CF organizational model are co-constructed in relation to a complex network of actors, practices, social relationships, professional groupings, work communities and professional identities.