Innovare verso un modello per Intensità delle Cure (IdC) offre agli ospedali importanti potenzialità di miglioramento, tanto a livello di qualità delle cure quanto sul piano organizzativo e gestionale. L’introduzione del modello IdC può tuttavia implicare sostanziali modifiche nell’organizzazione sociale del lavoro clinico, modificando relazioni, confini e identità professionali. La tesi esamina i reciproci effetti tra il modello IdC e l’organizzazione sociale del lavoro ospedaliero. Il disegno di ricerca è organizzato in tre fasi: una estensiva analisi documentale, uno studio esplorativo basato su interviste qualitative semi-strutturate, uno caso di studio etnografico in profondità condotto in un ospedale recentemente organizzato secondo il modello IdC. I risultati sono organizzati in tre studi. Il primo mostra come il cambiamento IdC sia stato diversamente interpretato dai manager ospedalieri e dai clinici in prima linea con i pazienti, costituendo così due discordanti ‘narrative di cambiamento’. Il secondo studio si focalizza sugli ostacoli alla creazione di team multidisciplinari negli ospedali IdC. Il terzo studio esamina l’impatto del modello IdC su relazioni e confini professionali tra medici e infermieri. Oltre a contribuire alle teorie socio-psicologiche riguardo a confini e identità professionali, la tesi propone riflessioni concrete su come colmare il divario tra programmi innovativi formali e pratiche di cura quotidiane. / The Patient-Centred Model (PCM) is described as an attempt to redesign the hospitals around the needs of the patients, thus contributing to costs reduction, increased efficiency, and improved care. However, the introduction of the PCM may have a profound impact on the social organisation of work, changing lines of demarcation, challenging well established inter-/intra-professional relationships, and prompting the development of new roles and modes of working. This thesis explores the mutual effects between the new organisational model and the pre-existent social organisation of hospital work. The research design is organised in three phases: an extensive document analysis; an interview study; an in-depth ethnographic case study conducted for over one year in a PCM hospital. The findings are organised in three studies. The first shows that the PCM was interpreted differently by hospital managers and by frontline clinicians, thus giving rise to two divergent narratives of change. The second study focuses on the boundaries to collaboration and care integration in newly created hospital teams within PCM hospitals. The third study looks at the impact of the PCM on the medical-nursing boundary. The thesis contributes to management learning and practice by providing recommendations on how to accompany complex innovations, comprising of both their expected and unexpected consequences. It also enriches academic debates on professional boundaries, relations, and identities in healthcare.

Thesis (Ph. D.)--Victoria University (Melbourne, Vic.), 2006. / Includes bibliographical references.

The creation of the National Health Service is treated, analytically and historically, as a planning process involving major changes in the social organisation of health as a part of the larger set of social and economic reconstruction policies undertaken by the wartime Coalition and postwar Labour governments. Definitions of 'health' are considered as relative both to social expectations and ideology, and to theoretical models of the organisation of health services. These models are identified with certain socio-political agents or interests in the providing and consuming of health services: professional groups, public and private authorities, non-professional workers, and the public. The models of the health service advocates and of the medical profession are considered as reference points. A framework is presented for the analysis of the representation of these interests, by the state, in the planning and operation of the NHS, and as beneficiaries of its services. Through a detailed historical consideration of internal health service planning documents of the major interests, including the medical profession, the health service advocates representing the Labour party and trade unions, and recently released documents of the Ministry of Health and the Coalition and Labour Cabinets, the interaction of the interests with the two governments and with each other is traced, and the reconciliation by the state of the health service models proposed by them is analysed. It is argued that the changes wrought in the social organisation of health in Britain can be described according to certain principles of the organisation of pre- and post-NHS health services: principles of public access, structure of services, structure of administrative control and structure of planning representation. Tne major interests were represented differentially by the state with respect to each of these criteria; similarities and differences between the approaches of the two governments to the representation of interests are examined, and it is concluded that, although the health service advocates and the public benefited from a free and universal scheme, the public and non-professional health workers enjoyed considerably less representation than the medical profession in the particular services provided by the NHS and in its planning and administration.

Thesis (Ph.D.) - James Cook University, 2004. / Thesis submitted by Sally Marie Babidge, BA (Hons) UWA June 2004, for the Degree of Doctor of Philosophy in the School of Anthropology, Archaeology and Sociology, James Cook University. Bibliography: leaves 283-303.