Evaluating the feasibility of Lombardy Region reform: the consolidation of a new model

The relationship between reform processes and organizational change capacity (Rebora and Minelli, 2012; Steward and Kringas, 2003; Klarner et al., 2008) is particularly complex; it is more evident in the health care services... [ view full abstract ]

The relationship between reform processes and organizational change capacity (Rebora and Minelli, 2012; Steward and Kringas, 2003; Klarner et al., 2008) is particularly complex; it is more evident in the health care services context that requires skills, efficient health clinics/LHA and high investment in order to face the increasingly patient-centered health and social care needs and to take in charge the fragile or chronic user.

This topic is particularly significant in the socio-cultural Italian context, where the need to integration health and social care services has been pursued since the birth of the health care system itself, and the same need has become even more urgent due to the progressive aging of the population. This evolution has radicalized the need for new models of health care service delivery (Hartley, 2005).

Within this framework, both in literature and in the real word, new conceptual designs of public administration reforms are evolving; starting from the classical model of Welfare, e.g. the “old public administration”, that was reformed by the New Public Management model (Ferlie et al. 1996; Hood 1995), up to a collaborative governance model, one more oriented to collaboration (Bovaird, 2005, 2008; Nabachi et al., 2012) among the different actors involved: institutions, stakeholders and patients.

Starting from this theoretical background (change management processes and reform models), the present paper analyses the evolution of the Lombardy health care model by comparing the emerging model with the recently approved reform and with the model that has been in use since 1996 to 2015.

Objectives of the analysis/research questions were:
a) Which model was actually adopted by the recent reform?
b) What were the reasons for the change and which aims does it want to achieve?
c) What are the possible conditions for the success of the ongoing reform in terms of value creation, and in relation to the problems that typically occur in organisational change processes?

From a methodological point of view, the case analysis was conducted through direct interviews with the protagonists of the reform process (councilors, regional general managers, heads of health care institutions).