Background: The objective of this study was to assess public hospital efficiency, including quality outputs, inefficiency determinants, and changes to efficiency over time, in an Italian region. To achieve this aim, the study used secondary data from the Veneto region for the years 2018 and 2019. Methods: A nonparametric approach—that is, multistage data envelopment analysis (DEA)—was applied to a sample of 43 hospitals. We identified three categories of input: capital investments (Beds), labor (FTE), operating expenses. We selected five efficiency outputs (outpatient visits, inpatients, outpatient visit revenue, inpatient revenue, bed occupancy rate) and two quality outputs (mortality rate and inappropriate admission rate). Efficiency scores were estimated and decomposed into two components. Slack analysis was then conducted. Further, DEA efficiency scores were regressed on internal and external variables using a Tobit model. Finally, the Malmquist Productivity Index was applied. Results: On average, the hospitals in the Veneto region operated at more than 95% efficiency. Technical and scale inefficiencies often occurred jointly, with 77% of inefficient hospitals needing a downsizing strategy to gain efficiency. The inputs identified as needing significant reductions were full-time employee (FTE) administrative staff and technicians. The size of the hospital in relation to the size of the population served and the length of patient stay were important factors for the efficiency score. The major cause of decreased efficiency over time was technical change (0.908) rather than efficiency change (0.974). Conclusions: The study reveals improvements that should be made from both the policy and managerial perspectives. Hospital size is an important feature of inefficiency. On average, the results show that it is advisable for hospitals to reorganize nonmedical staff to enhance efficiency. Further, increasing technology investment could enable higher efficiency levels.

The sustainable development challenge is increasingly being included in entrepreneurs’ agendas. Firms are considered responsible for social and environmental effects but are also considered as social actors that can effectively incorporate sustainability solutions into market transactions. The literature on corporate social responsibility (CSR) in small business has depicted these firms as less involved in sustainability management implementation owing to resource constraints and limited perception of the business case for sustainability. Further, studies on both small business and sustainable entrepreneurship have highlighted the pivotal role of entrepreneurs’ values in motivating a more sustainable way of conducting business while, large companies, driven by external pressures, are more focused on a strategic CSR approach than small firms. Starting from these premises, the paper aims to identify the main drivers or barriers of sustainability implementation and to verify any significant differences between small and large-sized companies in their approach to sustainability practices implementation. The study adopts a qualitative research method based on semi-structured interviews addressing 22 participants from Italian firms of different sizes selected for their social and environmental commitment. The findings of the study highlight the existence of some common features among small and large firms, in particular, regarding motivations, entrepreneur values, and business vision, contributing new perspectives to the sustainable entrepreneurship debate.

Several studies have underlined the importance of including sustainability issues in business models, yet little is known on ways in which to embed stakeholders’ influence in defining and executing firm strategies. In light of this gap, this study inductively develops a framework for stakeholder relationship assessment, which suggests methods to evaluate relationships between the firm and stakeholders, with a dual aim: to embed more sustainable strategies in business models and to make strategy execution more effective and less risky. In doing so, a case study is conducted on Science Lab owing to the multiple stakes of its stakeholders. It presents a unique example on how stakeholder relationships were evaluated for making a strategic decision that, in this case, was whether to close (or not) the organization. This study contributes to the existing literature stressing the role of stakeholders in influencing strategy realization and proposes a useful managerial tool to improve the effectiveness of strategy execution through a better understanding of the role played by each stakeholder.

Despite several studies highlighting the gap between strategy formulation and strategy implementation, strategy execution continues to be considered one of the greatest challenges in strategic management. Beginning from this premise, the present study explores how the gap between strategy formulation and implementation is perceived by middle-sized Italian companies. The basic idea of this study is to verify whether the difficulties that are widely reported in the strategic literature and empirical research of translating strategy into practice also arise in the context of Italian firms, and to examine which are the greatest barriers to successful strategy implementation. To address the research aims, we conduct a survey analysis of 544 middle-sized firms located in Northeast Italy. The findings of the analysis highlight how the main sources of the gap between strategy formulation and execution can be traced to two main factors: the processes through which the implementation step is conducted and the competences and skills necessary to effectively achieve the execution results. This paper contributes to the existing literature by conducting empirical research on the relevance of strategy execution in the Italian context. The study also has practical implications through its demonstration of the importance of some managerial tools that are highly useful in effective strategy execution.

In the presence of great uncertainty and volatility, the valuation of single assets or enterprises can be extremely complicated. Over the last few years, the European Securities and Market Authority (ESMA) has analyzed the potential impacts of these uncertainties on the application of the Impairment of Assets (IAS 36) accounting standards and exhorted firms adopting the IAS/IFRS accounting standards to consider multiple scenarios in forecasting information. This study, adopting a theoretical and conceptual perspective, aimed to analyze the theoretical and practical implications of the shift from single-path to multiple-scenario analysis. This paper contributes to the literature in the following ways: first, it suggests a new perspective of analysis that combines valuation needs with a strategic approach (a robust strategy). Second, it contributes to clarifying the antecedents and consequences of the ESMA recommendations. Furthermore, the paper also has practical implications as it highlights some critical issues associated with every valuation process, including the need to cope with growing uncertainty, the necessity of clarifying the great misunderstanding related to the confusion between the multiple-scenario valuation method and sensitivity analysis, and, last but not least, the importance of the relationship between strategy and the valuation process.

Scenario planning is a widely used methodology for identifying a broad array of risks and opportunities by analyzing and challenging decision-makers’ underlying assumptions. However, in the context of great uncertainty, which scenarios can help managers design effective strategic and financial planning and under what conditions? The paper attempts to answer this question by clarifying the relationship between strategy and planning, scenarios and strategy, and scenarios and plans. Using a representative model, the paper highlights the role of a robust strategy in navigating these complex relationships from both theoretical and managerial perspectives.