The Gap Between Service Design and Actual Implementation. A Case Study upon the Community Care Homes in Italy

In the last years, healthcare systems have been asked to redesign their service delivery process, towards the creation of health value to patients, within the entire value network of professionals, organizations, and institutions involved in the service supply within a specific geographical area. In Italy, a specific pillar of the Next Generation EU Programme is indeed dedicated to healthcare innovation, proximity assistance, and telemedicine. Among others, it has been found that the necessity of innovating the first access point, by redesigning the system towards an effective gatekeeping, with the involvement of GPs, together with a reengineering of the territorial health system. Starting from the above considerations, this chapter focusses on the fundamental role of the so-called Community Care Homes. In particular—considering the theories about the inertia and resistance to change in public organizations—it investigates the gaps between the idea and design formulated by the policymakers and the correspondences received by the side of health operators. We interviewed health to understand which distances exist and thus which problems arise in the actual implementation of a new (or reengineered) health service that appears definitively appropriate in its design but encounters obstacles in achieving the aims for which it is implemented. On the basis of our research results, we therefore suggest a few indications for more effective planning and design of health services, specially considering the full involvement of the operators since the preliminary phases, before the actual implementation, as a guarantee for a more effective health service execution.