The evaluation of healthcare organizations is complex due to the trade-offs between all healthcare features, benefits and costs to consider and the great number of stakeholders involved. Each healthcare policy is multidimensional and its criteria are both objective and subjective in nature, so multicriteria methods are appropriate decision-making tools for a general manager in the evaluation process. This paper proposes to evaluate the strategic policies of an Italian Healthcare Organization by means of the Analytic Network Process (ANP) integrated with a revised Balanced Scorecard (r-BSC) approach. This integrated network model allows one to take into account the micro-macro organizational setting opportunities and some normative constraints and incentives, typical of the Italian health context. So, it may be useful not only to rank strategic policies and derive priorities for perspectives, objectives and metrics involved in a strategic map, but also to assign a performance index to each element of the network model.
Healthcare organization, strategic management, Analytic Network Process, Balanced Scorecard, organizational decision making
Balduzzi, R. & Carpani, G. (2013). Manuale di diritto sanitario. il Mulino, Bologna.
Bentes, A.V., Carneiro, J., Ferreira da Silva, J., Kimura H. (2012). Multidimensional assessment of organizational performance: Integrating BSC and AHP, Journal of Business Research, 65, 1790-1799. Doi: http://doi.org/10.1016/j.jbusres.2011.10.039.
Bisbe, J. & BarrubÃ©s, J. (2012). The Balanced Scorecard as a management tool for assessing and monitoring strategy implementation in health care organizations. Rev. Esp. Cardiol. 65(10), 919-927. Doi: http://doi.org/10.1016/j.rec.2012.05.011.
Chang, L. (2007). The NHS performance assessment framework as a balanced scorecard approach. Limitations and implications. International Journal of Public Sector Management, 20(2), 101-117. Doi:
Chen M.Y., Huang M.J. & Cheng Y.C. (2009). Measuring knowledge management performance using a competitive perspective: an empirical study. Expert Systems with Applications, 36(4), 8449-8459. Doi: http://doi.org/10.1016/j.eswa.2008.10.067.
Cinelli, M. (2015). Diritto della previdenza sociale. Giappichelli, Torino.
Clerico, G. (2015). La governance della sanita pubblica. La coesistenza fra efficienza e qualitÃ . GiuffrÃ©.
Costa, G., Gubitta, P. & Pittino, D. (2014). Organizzazione aziendale. Italy: McGraw hill Education.
Figueras, J. & Mckee, M. (2012). Health systems, health, wealth and societal well-being, assessing the case for investing in health systems. McGraw Hill, Open University Press.
Forman, E.H. & Gass, S.I. 2001. The Analytic Hierarchy Process-An exposition, Operations Research, 49(4), 469-486. Doi: http://dx.doi.org/10.1287/opre.49.4.469.11231.
Fragale, E.N. (2013). La dirigenza delle aziende sanitarie dopo la c.d. riforma Balduzzi. Istituzioni del Federalismo, 2(2013), Note e commenti.
Gay, J.G., Paris, V., Devaux, M. & de Looper, M. (2011). Mortality amenable to health care in 31 Oecd countries, Paris, Oecd Health Working Papers, n.55. Doi: 10.1787/5kgj35f9f8s2-en.
Gosetti, G. & La Rosa, M. (2006). Sociologia dei servizi. Elementi di organizzazione e programmazione. Milano, Italy: Franco Angeli.
Hu, Y., Wen, J. & Yan, Y. (2015). Measuring the performance of knowledge resources using a value perspective: integrating BSC an ANP. Journal of Knowledge Management, 19(6),1250-1272. Doi: http://dx.doi.org/10.1108/JKM-10-2014-0431.
Kaplan, R.S. & Norton, D.P. (1996). Using the Balanced Scorecard as a strategic management system. Harvard Business Review, 74(1), 75â€“85.
Kaplan, R.S. & Norton, D.P. (1992). The balanced scorecard-Measures that drive performance. Harvard Business Review, 70(1), 71-79.
Liberatore, M.J. & Nydick, R.L. (2008). The analytic hierarchy process in medical and health care decision making: A literature review. European Journal of Operational Research, 189, 194-207. Doi: http://doi.org/10.1016/j.ejor.2007.05.001.
Marcarelli, G. (2016). Multi-criteria decision making for evaluating healthcare policies: the benefit/cost analysis by the analytic hierarchy process. International Journal of Medical Engineering and Informatics, 8(2), 163-181. Doi: http://dx.doi.org/10.1504/IJMEI.2016.075754.
Marmot, M. & Wilkinson, R.G. (2006). Using the Balanced Scorecard as a strategic management system, social determinants of health. Oxford: Oxford University Press.
Ovretveit, J. (1998). Evaluating health interventations. Maintenhead: Open University Press.
Nuti, S. & Seghieri, C. (2013). Is the variation management included in regional healthcare governance systems? Some proposals from Italy. Health policy, 114, 71-78. Doi: http://dx.doi.org/10.1016/j.healthpol.2013.08.003.
Pramod, V.R. & Banwet, D.K. (2010). Analytic Network Process analysis of an Indian telecommunication service supply chain: A case study. Service Science, 2(4), 281-293. Doi: http://dx.doi.org/10.1287/serv.2.4.281.
Ramanathan, R. & Ramanathan, U. (2011). A performance measurement framework combining DEA and balanced scorecard for the UK health sector. International Journal of Operational Research, 12(3), 257-278. Doi: http://dx.doi.org/10.1504/IJOR.2011.042916.
Ravi, V., Shankar, R. & Tiwari, M.K. (2005). Analyzing alternatives in reverse logistics for end-of-life computer: ANP and balances scorecard approach. Computers Industrial Engineering, 48, 327-356. Doi: http://doi.org/10.1016/j.cie.2005.01.017.
Reina, R. (2012). Organizzare i sistemi informativi per la sanita. Analisi e esperienze Giuffre ed.
Riccaboni, A., Busco, C., Bacci, A. & Del Medico, G. (eds) (2008). La Balanced Scorecard per lâ€™attuazione della strategia nelle Pubbliche Amministrazioni. Teoria, Casi ed esperienze. Knowita.
Saaty, T.L. (2005). Theory and applications of the Analytic Network Process: decision making with benefits, opportunities, costs and risks. Pittsburgh: RWS Publications.
Saaty, T.L. & Vargas, L.G. (1982). The logic of priorities: Applications in business, energy, health, and transportation. Boston: Kluwer-Nijhoff. Reprinted in Paperback (1991), Pittsburgh: RWS Publications.
Sloane, E.B., Liberatore, M.J., Nydick, R.L., Luo, W. & Chung, Q.B. (2003). Using the Analytic Hierarchy Process as a clinical engineering tool to facilitate an iterative, multidisciplinary, microeconomic health technology assessment. Computers and Operations Research, 30, 1447-1465. Doi: http://doi.org/10.1016/S0305-0548(02)00187-9.
Toth, F. (2014). La sanitÃ in Italia. Il Mulino.
Thakkar J., Deshmukh S. G., Gupta A. D. & Shankar R. (2007). Development of a Balanced Scorecard an integrated approach of Interpretive Structural Modeling (ISM) and Analytic Network Process (ANP). International Journal of Productivity and Performance Management, 56(1), 22-59. Doi:
Tjader Y., May J.H., Shang, J., Vargas L.G. &Gao N. (2014). Firm-level outsourcing decision making: a Balanced Scorecard-based Analytic Network Process model. International Journal of Production Economics, 147, 614-623. Doi: http://doi.org/10.1016/j.ijpe.2013.04.017.
Tjader Y., Shang, J. & Vargas L. (2009). Offshore outsourcing decision making: A policy-maker's perspective. Working paper, University of Pittsburgh. Doi: http://doi.org/10.1016/j.ejor.2010.03.042.
Tzeng M.L. (2010). Implementation and performance evaluation using the fuzzy network balanced scorecard. Computers & Education, 55, 188-201. Doi: http://doi.org/10.1016/j.compedu.2010.01.004.
Vargas, L.G. (1990). An overview of the Analytic Hierarchy Process and its applications, European Journal of Operational Research, 48(1), 2-8. Doi: https://doi.org/10.1016/0377-2217(90)90056-H.
Verzola, A., Bentivegna, R., Carandina, G., Trevisani, L., Gregorio, P. & Mandini, A. (2009). Multidimensional evaluation of performance: experimental application of the balanced scorecard in Ferrara university hospital. Cost Effectiveness and Resourse Allocation, 7(15), 1-8. Doi: 10.1186/1478-7547-7-15.
Zelman, W., Pink, G., Matthias, C. (2003). Use of the Balanced Scorecard in health care. Journal of Health Care Finance, 29(4), 1-16.
World Health Organization (Regional Office for Europe) (2013). Health 2020: a European policy framework supporting action across government and society for health and well-being.
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