The paper presents an in-depth case study of the NEMO Centre in Italy, a healthcare no-profit organisation that provides highly specialised services for neuromuscular diseases, for adults and children. NEMO started in 2008 as... [ view full abstract ]
The paper presents an in-depth case study of the NEMO Centre in Italy, a healthcare no-profit organisation that provides highly specialised services for neuromuscular diseases, for adults and children. NEMO started in 2008 as the first centre targeted to these complex patients who could not find any integrated care answer in the public or private sector nor services concentrating the multi-disciplinary competences and expertise required. The NEMO Centre rose from the collaboration of patients’ associations, which established a No-profit Foundation, that sought for managing and contracting partnerships with public hospitals wherein the NEMO Centre and the new service delivery model have been set up. The Centre has constantly grown: it succeeded in covering previous unmet needs with high efficacy relying on the patient-centred approach and with great efficiency based on the institutional public-no profit partnership design. After seven years of continuous growth, the service delivery model achieved a breakeven point: improve the original institutional and organizational model to meet the services’ expansion required or draw back from innovative strategies.
The paper exploits the managerial case study approach to analyse the NEMO experience and provide alternatives for developing future strategies. To this extent the managerial approach to co-production in service delivery in health care is applied, the so called People Powered Health model. Data, indeed, were collected either through the quantitative analysis on results achieved in two NEMO Centres, from two Integrated Care Pathways (ICPs) – one on the Amyotrophic Lateral Sclerosis (adults) and one on the Duchenne Muscolar Dystrophy (children) – to assess the efficacy of the care delivery model of co-production. Qualitative data indeed were collected through a panel of in-depth interviews with the key stakeholders who set up the original model of service delivery and the idea of partnership between public and a private no-profit foundation. Stakeholders from the public authorizing environment indeed have been included in the panel of interviews. The latter were recorded and analysed through content analysis and the use of NVIVO software to detect different stakeholders’ perspectives.
Results provides interesting lesson learnt over the NEMO experience as well generalizable implications for the scaling up and spread-out of similar experiences. Whereas there are robust proves of efficacious care provided, the future sustainability of the service model requires the development yet of the public-sector culture yet of the managerial maturity and positioning of the patients’ associations’ board (the foundation). The new enlargements, propelled by the associations, clash with the need of structuring and formalizing an inter-organisational network of expert Centres. The new Centres in fact exploited heterogeneous institutional designs due to different contextual factors, political and regulatory ones. Indeed, any expansion in a very competitive, knowledge based and professionalized environment require investments in research in advance therapies and rehabilitation technologies. The successful attainments of partnerships between private no-profit and the public need to be fueled over time and get to formailsed models, beyond the nature of piloting projects that co-production and co-design could have wherein expert professionals and managers are not accepted to hold managerial roles.
Value co-creation, co-design and co-production in public services
