Fighting health inequalities is a challenge addressed by the United Nations Strategic Development Goals (UN-SDGs). Particularly, people living in rural areas suffer from a lack of health infrastructure, which would jeopardize their inclusion in universal coverage for specialist care. Delivering valuable healthcare in underserved areas can be achieved through the employment of new technical innovations, such as telemedicine, which improves service delivery processes. Accordingly, this paper discusses how telemedicine strategies have enhanced the sustainability of right of “access to healthcare” in rural areas. Once we derived the sustainability pillars for healthcare from the UN-SDGs 3 and 10 according to the WHO innovation assessment metrics, a PRISMA-based literature review was conducted using the Scopus database. English, peer-reviewed articles/reviews from 1973 to 2019 were considered. The enquiry covers two analyses: (i) quantitative-bibliometric on 2267 papers; and (ii) qualitative-narrative on the 30 most significant papers. Interest about the topic has increased in the last decade following digitalization diffusion. The most productive and collaborative countries are those with huge dimensions and under financial restrictions. From a sustainability-oriented standpoint, telemedicine enhances both emergency and diagnostic healthcare in rural areas by decreasing the cost of services, expanding coverage of specialist cares, and increasing the quality of the outcomes. For health policies, telemedicine can be considered a suitable solution for providing cost-effective and sustainable healthcare.

Purpose: Digital transformation (DT) is a priority for the healthcare sector. In many countries, it is still considered in the early stages with an underestimation of its benefits and potentiality. Especially in Italy, little is known about the impact of digitalization – particularly of the Internet of Things (IoT) – on the healthcare sector, for example, in terms of clinician's jobs and patient's experience. Drawing from such premises, the paper aims to focus on an overlooked healthcare area related to the chronic heart diseases field and its relationship with DT. The authors aim at exploring and framing the main variables of remote Monitoring (RM) adoption as a specific archetype of healthcare digitalization, both on patients and medical staff level, by shedding some lights on its overall implementation.Design/methodology/approach: The authors empirically inquiry the RM adoption within the context of the Cardiology Department of the Casilino General Hospital of Rome. To answer our research question, the authors reconstruct the salient information by using induction-type reasoning, direct observation and interviewees with 12 key informants, as well as secondary sources analysis related to the hospital (internal documentation, presentations and technical reports).Findings: According to a socio-technical framework, the authors build a model composed of five main variables related to medical staff and patients. The authors classify such variables into an input-process-output (I-P-O) model. RM adoption driver represents the input; cultural digital divide, structure flexibility and reaction to change serve the process and finally, RM outcome stands for the output. All these factors, interacting together, contribute to understanding the RM adoption process for chronic disease management.Research limitations/implications: The authors' research presents two main limitations. The first one is related to using a qualitative method, which is less reliable in terms of replication and the interpretive role of researchers. The second limitation, connected to the first one, is related to the study's scale level, which focuses on a mono-centric consistent level of analysis.Practical implications: The paper offers a clear understanding of the RM attributes and a comprehensive view for improving the overall quality management of chronic diseases by suggesting that clinicians carefully evaluate both hard and soft variables when undertaking RM adoption decisions.Social implications: RM technologies could impact on society both in ordinary situations, by preventing patient mobility issues and transport costs, and in extraordinary times (such as a pandemic), where telemedicine contributes to supporting hospitals in swapping in-person visits with remote controls, in order to minimize the risk of coronavirus disease (COVID-19) contagion or the spread of the virus.Originality/value: The study enriches the knowledge and understanding of RM adoption within the healthcare sector. From a theoretical perspective, the authors contribute to the healthcare DT adoption debate by focusing on the main variables contributing to the DT process by considering both medical staff and patient's role. From a managerial perspective, the authors highlight the main issues for RM of chronic disease management to enable the transition toward its adoption. Such issues range from the need for awareness of the medical staff about RM advantages to the need for adapting the organizational structure and the training and education process of the patients.

Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future.

The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA.

Background: Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention. Methods: A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed. Results: We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level. Conclusions: While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how “value co-creation” could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

Purpose: Artificial intelligence (AI) can help in defining preventive strategies in taking decisions in complex situations. This paper aims to research how workers might deal with intervening AI tools, with the goal of improving their daily working decisions and movements. We contribute to deepening how workers might deal with intervening AI tools aiming at improving their daily working decisions and movements. We investigate these aspects within a field, which is growing in importance due to environmental sustainability issues, i.e. waste management (WM). Design/methodology/approach: This manuscript intends to (1) investigate if AI allows better performance in WM by reducing social security costs and by guaranteeing a better continuity of service and (2) examine which structural change is required to operationalize this predictive risk model in the real working context. To achieve these goals, this study developed a qualitative inquiry based on face-to-face interviews with highly qualified experts. Findings: There is a positive impact of AI schemes in helping to detect critical operating issues. Specifically, AI potentially represents a tool for an alignment of operational behaviours to business strategic goals. Properly elaborated information, obtained through wearable digital infrastructures, allows to take decisions to streamline the work organization, reducing potential loss due to waste of time and/or physical resources. Research limitations/implications: Being a qualitative study, and the limited extension of data, it is not possible to guarantee its replication and generalizability. Nevertheless, the prestige of the interviewees makes this research an interesting pilot, on such an emerging theme as AI, thus eliciting stimulating insights from a deepening of information coming from respondents’ knowledge, skills and experience for implementing valuable AI schemes able to an align operational behaviours to business strategic goals. Practical implications: The most critical issue is represented by the “quality” of the feedback provided to employees within the business environment, specifically when there is a transfer of knowledge within the organization. Originality/value: The study focuses on a less investigated context, the role of AI in internal decision-making, particularly, for what regards the interaction between managers and workers as well as the one among workers. Algorithmically managed workers can be seen as the players of summarized results of complex algorithmic analyses offered through simpleminded interfaces, which they can easily use to take good decisions.