During the first wave of the Pandemic, that hit Italy mostly in Northern regions, the Lombardy Regional Healthcare System has been widely criticised for its response to the spread of Covid-19. Lombardy is the first region in Italy in terms of inhabitants, 10 million or 17% of the national population, accounting for 22% of the national GDP (ISTAT, 2022). In spite of an excellent hospital system, Lombardy was criticised for the apparent weakness of the territorial setting of care. The latter had been the target, before Covid-19, of some key policy reforms aimed at taking charge of chronic diseases outside of hospitals (e.g., Amaducci et al. 2013). Nowadays, the investment plan outlined in the National Recovery and Resilience Plan, mostly financed by European funds, is seeking a boost in territorial care, identifying several different territorial settings and actors to respond to health needs of the citizens. The conception and planning of these investments have been certainly inspired by the Lombardy approach, that, in January 2022, was responsible for managing around 5% of the regional chronically ill population. In this system a physician can design an individual plan of care for a chronically ill individual, including the yearly planning of drug prescriptions, medical exams, specialised medical check-ups as well as lifestyle recommendations. This programming approach prevents the patient from dealing with the administrative burdens of repetitive prescriptions and allows the doctor to be consulted only in case of unexpected outcomes.

This paper, building on original regional data, is seeking to understand which factors favoured the adoption of chronic disease management logic amongst general practitioners and other physicians and to draw implications for healthcare managers. On the one hand, the paper uses original regional data provided, in aggregated form, by the Region; on the other hand, we corroborate our analysis with a survey provided to selected general practitioners. The work is the result of the ongoing involvement of the research team in the current policy reform process of the Region to improve territorial care, allowing the researchers to observe and support change within and through their study, in a way that could be understood as action research (Merchant & Otley, 2020).

The main evidences emerged from data analysis show that Covid-19 has halted the expansion of the program in the Region. We depict the typical patient that receives an individual plan as a chronically ill, between 70 and 79 years old, affected by a number of pathologies which may vary between one and three, being mostly hearth diseases or diabetes. In relative terms, individuals are more likely to live in one of the Northern and more sparsely populated provinces of the Region than in Milan or the surrounding provinces. We also show that the policy was mostly fostered by general practitioners operating in associations (95% of the practitioners who develop clinical plans are part of cooperatives), and for a smaller portion from specialised physicians mostly focused on multimorbid individuals affected by four or more pathologies. When asked about their attitudes towards chronic disease management, the most credited answer given by general practitioners highlight that this approach helps them in optimising clinical management processes while the two second ones refer respectively to its capability to clarify the care path to the patient while the second tied recognises the strong incentive promoted by the cooperative in fostering the adoption. The answer concerning possible economic incentives in redacting the clinical plan was instead one of the least popular between the respondents.

The implications for healthcare managers are twofold: on the one hand, chronic disease management should be fostered through a combination of top-down indications, targeted economic incentive, and ameliorative services that ease the burden on both the physician and the patient; on the other hand, the territorial system should sharply distinguish the roles and responsibilities, encouraging mechanisms of collaboration between professionals as the complexity of the patient changes.

Background: Our modern societies depend on infrastructure such as roads, power, water and broadband to function. Local infrastructure asset management is not only necessary to ensure that everyday life can continue, however, but also to lessen the effects of climate change (IPCC, 2022).

In both Sweden and a number of other countries, much of the responsibility for local infrastructure is placed on a municipal level. Thus, municipalities have great responsibilities when it comes to ensuring the development towards a sustainable society. Despite this, many countries face a long line of challenges when it comes to both maintenance of existing infrastructure, and investments in existing and new facilities. Increased urbanisation and changed residential patterns require local infrastructure adaptations to suit new demographic conditions. In addition to existing infrastructure starting to become outdated.

Municipalities have limited access to resources and lacks the capacity necessary to finance plan and work with asset management. Our knowledge around how municipalities could work more strategically and long-term with asset management in critical infrastructure networks is limited. What we do know, is that municipalities choose to collaborate with other municipalities in order to increase their resource base. Our knowledge around the extent to which cooperation actually leads to an increased resource base, and thus increased organisational capacity, is however limited.

Purpose: The purpose of this study is to investigate how inter-municipal cooperation contribute to increase organisational capacity and as a consequence of this enable municipalities’ to work more strategically with asset management and contribute to a more long-term sustainable development of critical infrastructure.

Theory: To investigate how inter-municipal cooperation contribute to increase organizational capacity we take the point of departure in literature on organizational capacity. Organizational capacity is a multidimensional concept that captures many dimensions of an organization. For this study we take the point of departure in de Loë et al., (2002), and later Alm et al., (2021) definitions of organizational capacity as consisting of five mutually related factors: technical, financial, institutional, political and social capacity.

conceptualisation of local capacity that is based on five mutually related factors: technical, financial, institutional, political and social capacity, and even if the significance of each individual one of the factors varies from one organisation to the next, they are related to each other, and affect each other and an organisation’s ability to reach its goals.

Method and empirical material: This study is based on a qualitative, oriented, longitudinal case study of a Swedish inter-municipal cooperation within water service provision. The case study was conducted over a period of ten years. During this time the researchers visited the organisation on several different occasions. The longitudinal approach made it possible to study how organizational capacity developed over time.

Contributions: The results of the study show that cooperation can contribute to increased organisational capacity; cooperation seems able to especially contribute to the technical, financial and social capacity of an organisation. For cooperation to work, however, the organisation itself has to develop its political capacity.

References:

Alm, J., Paulsson, A., Jonsson, R., 2021, “Capacity in municipalities: Infrastructures, maintenance debts and ways of overcoming a run-to-failure mentality.” Local Economy, Vol. 36, s. 81-97

De Loë, R., di Giantomasso, S.E., & Kreutzwiser, R.D. (2002). “Local capacity for groundwater protection in Ontario”. Environmental Management, 29(3), 217-233