RISULTATI RICERCA

La Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico è un centro di riferimento regionale e nazionale per l’attività clinica, di ricerca e formazione. Si caratterizza per essere un centro d’eccellenza per diverse attività di cura, come l’emergenza-urgenza nell’adulto e nel bambino, i trapianti, l’assistenza materno-infantile e la presa in carico dei pazienti con malattie rare. La Fondazione è anche un esempio virtuoso di prevenzione e gestione del rischio clinico per la sicurezza dei pazienti e professionisti. Il team del rischio clinico, all’interno della Direzione Qualità, è impegnato in una forte attività di ottemperanza alla normativa vigente tramite la redazione di protocolli e procedure e la verifica della loro applicazione con audit programmati e non programmati. Gli interventi di prevenzione del rischio clinico non si limitano al rispetto della normativa, ma prevedono campagne formative o attività su tematiche specifiche rivolte a pazienti e operatori, come le aggressioni o le cadute. L’attività sia di prevenzione sia di monitoraggio è caratterizzata da un forte approccio partecipativo che vede il coinvolgimento delle unità operative e dei loro referenti qualità e rischio clinico. La Fondazione sta migrando verso l’applicazione del sistema Enterprise Risk Management favorito dalla partecipazione al network regionale per il rischio clinico.

L’ambito delle riflessioni finalizzate a perseguire la migliore gestione delle risorse per quella che potrà essere la Sanità del Futuro non poteva non includere la L. n. 24/2017 (c.d. Legge Gelli-Bianco) a oltre 6 anni dalla sua entrata in vigore. La survey ha indagato le seguenti aree: caratteristiche e parametri dimensionali dell’Azienda; descrizione della governance, malpractice medica/contenzioso; descrizione della strategia economico-finanziaria utilizzata; rilevazione fenomenologica della valutazione del rating professionale aziendale ed interazione malpractice medica-governance clinica. La metodologia di raccolta delle informazioni e dei dati relativi a questi argomenti ha preventivamente tenuto conto della possibile grande eterogeneità delle diverse articolazioni aziendali nonché della relativa bassa conoscenza di alcuni termini o fasi operative. Sono presentati poi i dati relativi a 3 temi suddivisi per nord, centro e sud. I principali risultati sono sintetizzati nei seguenti termini: valutazione sinistri, impatto del rischio clinico-sanitario, gestione economica finanziaria, strumenti economico-finanziari e affidabilità professionale. Assenza di un affidabile metodo di verifica dei risultati ottenuti. In vari contesti è dichiarata la riduzione della sinistrosità senza il supporto di evidenze empiriche in quanto questa dinamica può essere valutata per un periodo lungo superiore a quello degli incarichi manageriali. Altro aspetto importante sembra emergere dalla non adeguata attenzione su alcuni elementi come le cartelle cliniche e le adeguate expertise professionali nella gestione di processi che hanno un impatto economico rilevante per l’Azienda. Nelle regioni del sud e del centro la gestione della malpractice medica sembra emergere come un “problema” da risolvere piuttosto che un’opportunità di gestire meglio le risorse e il rischio clinico. Infine uno degli aspetti critici più evidenti sembra essere quello del collegamento tra le informazioni rilevabili dai casi denuncia di malpractice medica e la gestione dei rischi clinico-sanitari. L’assenza di un adeguato studio statistico e analitico di tali dati riduce l’impatto sul rischio quasi esclusivamente ad azioni reattive (audit) con limitate attenzioni agli interventi sulle principali risorse di governance clinica.

The aim of this study is to compare regional ecosystems’ resilience in terms of their ability to contain the spread of Covid-19. This is carried out through institutional measures as well as through spontaneous community behaviour in order to preserve public health and the institutional actions to strengthen the health-care system in dealing with the pandemic. The discussion is framed through the institutional approach. We develop a twostep method. In the first step, regions have been clustered by considering the kind of response to Covid-19, in terms of formal and informal rules. In the second step a random effect panel regression analysis was performed in order to define the effect of the single response variable to Covid-19 on the resilience index over time. Implications for policy makers are then discussed. The first is that coping with a regional emergency requires taking into account regional specificities. Strictly imitative models risk being inconsistent with the characteristics of the area, resulting in outputs that are not homogeneous. The second involves social capital, which is crucial to the application of the norms. In regions with high social capital there is a sense of solidarity that presents itself in informal rules aimed at reinforcing the formal rules. However, there is no sense of conformity for the sake of conformance to the standard.

Purpose. The paper aims to understand if digital healthcare can improve young and chronic patient engagement. The interpretation follows the doctor-patient relationship, investigating whether telemedicine fosters patients’ engagement and, if they are young, also of their caregivers. Methodology. The study analyses two Italian digital healthcare cases. A questionnaire and semi-structured interviews are administered to detect information on the new telemedicine service’s satisfaction, utility, and usability. Context. The study shows that e-health can answer the widespread need for well-being without space and time limits, before and during the pandemic, especially in Italy. It allows the humanization of a technology-driven system, which requires strong patient and community engagement to be built simultaneously. Main findings. E-health can be a tool to improve the doctor-patient relationship and create a sense of community among patients. Moreover, patient engagement in a technology-driven healthcare environment is necessary to implement new treatments successfully. Conclusion. We tested new digital healthcare services unique in Italy to understand the point of view of young and chronicle patients and their caregivers to contribute to a bottom-up harmonization process of e-health.

The adoption of new patient treatment initiatives has been necessitated by the current pandemic crisis and the need for social distancing to protect doctors and patients. The main initiatives to respond pandemic crisis is the adoption of telemedicine tools which provides for the diagnosis or medical service provided by a doctor to patients in digital mode. The aim is the remote monitoring of patients’ health status, allowing direct involvement of patients at home. On these premises, this study offers a mapping of the digital solutions adopted in the Calabria region by health organizations during the Covid-19 pandemic with the aim of specifically analyzing the role of telemedicine in supporting home healthcare during the Covid-19. This study provides insights into the potential of telemedicine to support home healthcare, as a response to the Covid-19 crisis now and in the future.

The Covid-19 pandemic is generating disruptive changes in the healthcare sector, drastically transforming the functioning of its organizational arrangements. In the light of recent developments and the adoption of new digital technologies in the healthcare system, we aim at exploring new trends adopted within the Italian healthcare setting in response to the pandemic crisis. Specifically, through the methodology of Web Content Analysis, it is possible to identify the most relevant emerging healthcare responses to the Covid-19 pandemic, that is digital health, telemedicine, and patient-centeredness, that suggest a roadmap to follow within the healthcare system. Implications for theory and practice are discussed.

Recently, the literature observed a significant growth of studies on the healthcare communities of practice, above all for their contribution in addressing the health crises, and in particular the Covid-19 pandemic. However, the literature on the topic is still fragmentary, especially with concern of the bottom-up citizens’ engagement approach. This study aims to explore the contribution of healthcare communities of practice in addressing the Covid-19 pandemic through the citizens engagement. Based on the casestudy method, we conducted a qualitative analysis on the community created in Italy named “Comitato Cura Domiciliare Covid” (Covid Home Care Committee). The paper focuses on the experience of this health care community of practice, seeking to identify major challenges and opportunities for supporting policymakers and clinicians dealing with a health crise.

The use of information and communication technologies (ICT) is a twenty-first-century approach that is patient-centered and protects patients, physicians, and others. Where key actors are more interested in social value creation than in value capture (Santos, 2012), health services ecosystems can generate strongly positive externalities and be sustainable. Digital ICT technologies spanning robotics, artificial intelligence, remote patient monitoring, and telemedicine have improved equitable access to care and participated in the sustainable agenda, nurturing an ecosystem of caregiving interaction. Therefore, framing research on information systems in healthcare related to the SDGs can be helpful in the innovation of healthcare organizations in dealing with the pandemic and the post-pandemic. The primary purpose of this special issue is to identify the role and relevance of ICT in healthcare ecosystems while promoting sustainability. Various topics emerge within this special issue, such as Governance models, institutional relations, and social capital; the role of ICT in the healthcare system changes and finally, the use of digital innovations and ICT in pandemics and post-pandemics. In this special issue, we build on this knowledge base and expand the research direction on developing innovation and digital technologies for sustainable health ecosystems.

In Taiwan’s niche coffee market, there is a clear demand for sustainability, yet there remains a gap in understanding certification preferences. This study addresses this gap by employing the Theory of Planned Behavior (TPB) to investigate the purchase intentions of 348 Taiwanese consumers towards environmentally-labeled coffee. Structural equation modeling reveals positive associations between attitude, subjective norms, perceived behavioral control individually, and purchase intention. Among the factors influencing attitude, sensory, upscale, and environmental beliefs significantly play significant roles, while health beliefs do not. Probit regression analysis confirms that purchase intention positively influences consumers’ willingness to engage in coffee consumption. In additon, consumer characteristics including past experience, household size, knowledge, and age also impact coffee consumption willingness. These findings provide valuable insights for stakeholders seeking to promote sustainable consumption and guiding environmentally-conscious decisionmaking strategies.

The European Union agri-food system has faced major challenges in the last years due to the Covid-19 pandemic and the Russian-Ukrainian war. In a scenario where millions of people all over the world suffer from hunger, the uncertainty of food availability and commodity price surge have made it difficult for them to find and afford food on a large scale even in countries, which apparently are not exposed to those risks. Within the European Union (EU), this has depended upon the vulnerabilities and dependencies inherent in the agri-food system. In order to react and cope with emergency scenarios, the European Institution has adopted some temporary measures. The present paper, verifies the level of the EU agri-food Self-Reliance system through the development of Self-sufficiency calculation and the Import Dependency Index as well as the EU comparative advantage through the Gerard-Lafay Index and the relative comparative advantage (Vollrath). On the basis of the achieved results, recommendable actions have been suggested in order to secure the food supply on one hand, and satisfy the EU demand even in case of future adverse events, on the other. In addition, further actions that need to be taken, recommended by the European institutions, have been described.

Dried pasta is depicted as the most traditional and popular Italian food culture. Italy has the highest per capita pasta consumption worldwide, but lifestyle changes define new habits and trends in consuming this traditional Italian food. The present study aims to explore organic consumers’ knowledge, attitudes and preferences for dried pasta and, specifically, the relevance of organic and “ancient” durum wheat varieties.Results show limited knowledge of consumers about dried pasta characteristics and the relevance of extrinsic cues, especially those related to expected taste and local origin. Therefore, the most relevant claims for improving the communication strategy of dried pasta are identified. Companies should meet consumers’ preferences by increasing investments in the innovation of this staple food with a focus on improving production processes and packaging design with more effective front-of-pack communication. The findings provide insights into the pasta market, which may help organic companies to enter this new market and make their products more appealing to consumers.

In Colombia, the agricultural sector is a strategic point to generate development in the territories; but few governmental actions are implemented to achieve it, therefore, the objective of this research is to explain how the rural development of Vereda Vergel in Palmor-Ciénaga Magdalena, Colombia, has taken place based on the productive activities developed by its inhabitants under the criterion of governance of the community itself focused on its welfare. Methodologically, it is classified as a descriptive-explanatory field study with a qualitative approach, following the theoretical postulates of Alburquerque (2007) and Martínez de Anguita (2006). As a data collection technique, an interview script was applied to a focus group formed by farmers of the village. The main finding shows that there is no planning in the territory to promote the rural development generated within the community; however, the community diversifies its productive activity in fruit and bread crops such as lemon, mango, strawberry, coffee, yucca, yams; on the other hand, animal husbandry: chickens, ducks, pigs and cows, as well as beekeeping activities. In this sense, all the primary production and handcrafted processed products

Agricultural businesses are often faced with uncertainty about the future, which can be both an opportunity and a threat to business development. This study aims to formulate a strategic foresight for business development at the Indonesian Orchid Association (IOA) West Java, Indonesia. Data collection was carried out using interview techniques and a literature study. Respondents were selected using a purposive sampling consisting of 18 business actors in IOA West Java, 2 employees of the Department of Food Crops and Horticulture West Java, and 1 BRIN researcher. The business development is planned with strategic foresight. The result showed that the driving factors that most influence businesses are the role of IOA West Java and the application of tissue culture technology. Strategic foresight for the next 5 years is focused on increasing farmer competence, applying tissue culture technology, and building market certainty, for the next 10 years, it is focused on meeting domestic demand for orchids by at least 50%, and for the next 15 years, it is focused on business continuity and increasing competitiveness.