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There is an emerging body of research on the co-design of public services, including co-design with vulnerable adults. However, what has been less explored has been the impact of digital technology and virtual environments upon the co-design process in this context. This paper analyses the contingencies of virtual co-design through a case study of a project to develop supportive local communities for vulnerable elderly people. This project was initially planned to use traditional co-design methods within a face-to-face environment, in the context of the local public service ecosystem. The CoVid-19 pandemic made this impossible. Consequently, an innovative approach to co-design was developed that shifted the process from a face-to-face to a virtual environment. This exploratory paper reports and evaluates this approach and its implications for the future of the theory and practice of the co-design of public services for vulnerable adults. Theoretically the paper evolves a model of co-design in a virtual space that is embedded within a public service ecosystem framework of value creation. At a practice level, the paper provides insight into the strategic and operational management of co-creation in a virtual space. It evolves the ‘Relay’ model of asynchronous co-creation across time and considers it key contingencies.

Turbulence appears to be a “new normal” in current societies, and public organizations need to learn how to react and adapt to it. Scholars agree on the need for robust actions to respond to turbulence. Through a qualitative comparative analysis performed on the vaccination campaigns of all 20 Italian regions, our paper explores whether different and alternative models of robustness may exist to cope with turbulence. Results shed light on three alternative models featuring static, hybrid, and dynamic robustness. They also highlight that robust governance appears to involve a capacity to learn, and to employ this learning as circumstances demand.

Parental hesitancy poses a serious threat to the success of the COVID-19 childhood vaccination campaign. We investigate whether adults' opinions on childhood vaccination can be influenced via two survey experiments in Italy (n=3,524 participants) and the UK (n=3,066 participants). Respondents were randomly assigned to: a “risk treatment” that highlighted the potential risks of COVID-19 to a child, a “herd immunity treatment” that emphasized the community benefits of pediatric vaccination, or a control message. Participants’ probability of supporting COVID-19 childhood vaccination was then assessed on a 0-100 scale. We find that the “risk treatment” reduced the proportion of Italian parents strongly against vaccination by up to 29.6%, while increasing the proportion of neutral parents by up to 45.0%. The “herd immunity treatment”, instead, was only effective among non-parents, resulting in a lower proportion of individuals against pediatric vaccination and a higher proportion of individuals in favor (both shifted by around 20%).

Editor’s note. In this roundtable, the contributors discuss the role of institutions (or lack thereof) in behavioral public administration (BPA). In a multidisciplinary discourse, the contributors touch on the many tensions that exist between institutional and behavioral perspectives of public administration. This roundtable is intended to spark additional discourse on the role of institutions in how they parameterize behaviors within or how individual behaviors might, in the aggregate, influence the norms and rules that shape institutions. Here at JBPA, we encourage further dialogue on the role of institutions in behavioral studies and holding work from a macro-, meso-, and micro-lens accountable to each another (Jilke et al., 2019). The editorial team at JBPA is thankful to Herbert Simon Award (Midwest Political Science Association) winners Anthony Bertelli (2020) and Norma Riccucci (2021) for organizing this thoughtful conversation. We hope that the discussion offered in this roundtable will inspire further inquiry from our readers. We encourage thought leaders in the field of public administration and beyond to continue this conversation here at JBPA. Therefore, we are announcing a Call for Papers, in response to this roundtable. Contributing papers can take one of several forms: (1) Research Letters (of no more than 2,000 words), for instance, might provide replications of existing work in BPA where the replications newly account for institutional embeddedness. (2) Perspective and Practices submissions (generally limited to 4,000 words) should be written as thoughtful responses to the discourse below, and (3) Research Articles (up to 8,000 words) can be more thoroughly threshed out theoretical conceits about institutions in BPA. William G. Resh, Editor-in-Chief

Digital health and mobile medical apps (MMAs) have shown great promise in transforming health care, but their adoption in clinical care has been unsatisfactory, and regulatory guidance and coverage decisions have been lacking or incomplete. A multidimensional assessment framework for regulatory, policymaking, health technology assessment, and coverage purposes based on the MMA lifecycle is needed. A targeted review of relevant policy documents from international sources was conducted to map current MMA assessment frameworks, to formulate 10 recommendations, subsequently shared amongst an expert panel of key stakeholders. Recommendations go beyond economic dimensions such as cost and economic evaluation and also include MMA development and update, classification and evidentiary requirements, performance and maintenance monitoring, usability testing, clinical evidence requirements, safety and security, equity considerations, organizational assessment, and additional outcome domains (patient empowerment and environmental impact). The COVID-19 pandemic greatly expanded the use of MMAs, but temporary policies governing their use and oversight need consolidation through well-developed frameworks to support decision-makers, producers and introduction into clinical care processes, especially in light of the strong international, cross-border character of MMAs, the new EU medical device and health technology assessment regulations, and the Next Generation EU funding earmarked for health digitalization.

In the absence of widespread vaccination for COVID-19, governments and public health officials have advocated for the public to wear masks during the pandemic. The decision to wear a mask in public is likely affected by both beliefs about its efficacy and the prevalence of the behavior. Greater mask use in the community may encourage others to follow this norm, but it also creates an incentive for individuals to free ride on the protection afforded to them by others. We report the results of two vignette-based experiments conducted in the United States and Italy to examine the causal relationship between beliefs, social norms, and reported intentions to engage in mask promoting behavior. We find that providing factual information about how masks protect others increases the likelihood that someone would wear a mask or encourage others to do so in the United States, but not in Italy. There is no effect of providing information about how masks protect the wearer in either country. Additionally, greater mask use increases intentions to wear a mask and encourage someone else to wear theirs properly in both the United States and Italy. Thus, community mask use may be self-reinforcing.

As the clinical trials for COVID-19 vaccine progress, understanding how to distribute the initially scarce doses is of paramount importance and a quantitative analysis of the trade-offs involved in domestic-only versus cooperative distribution is still missing. In this study we use a network Susceptible-Infected-Removed (SIR) model to show under which circumstances it is in a country’s self-interest to ensure other countries can also obtain a COVID-19 vaccine rather than focusing only on vaccination of their own residents. In particular, we focus our analysis on the US’s decision and estimate the internal burden of COVID-19 disease under different scenarios about vaccine cooperation. We show that in scenarios in which the US has reached the threshold for domestic herd immunity, the US may find it optimal to donate doses to other countries with lower vaccination coverage, as this would allow for a sharp reduction in the inflow of infected individuals from abroad.

Introduction: The unparalleled surge in digital health adoption during the COVID-19 pandemic has emphasized the potential of mHealth apps. However, the quality of available evidence is generally low, and regulatory frameworks have focused on apps with medical purposes only, overlooking apps with significant interactions with patients that may require stronger oversight. Areas covered: To support this expanded evidence generation process, we identified the reasons that distinguish mHealth apps compared to medical devices at large and that should differentially feature their assessment. mHealth apps are characterized by the iterative nature of the corresponding interventions, frequent user interactions with a non-linear relationship between technology usage, engagement and outcomes, significant organizational implications, as well as challenges associated with genericization, their broad diagnostic potential, and price setting. Expert Opinion: The renewed reliance experienced during the pandemic and the unprecedented injection of resources through recovery instruments can further boost the development of apps. Only robust evidence of the benefits of mHealth apps will persuade health-care professionals and beneficiaries to systematically deploy them. Regulatory bodies will need to question their current approaches by adopting comprehensive evaluation processes that adequately consider the specific features of mHealth apps.

This article explores the application of strategic planning and management to public service organizations (PSOs). It argues that the impact of these approaches has been limited by the absence of a...

Over the last decades, one of the most significant changes in the workplaces of government agencies around the world has been the introduction of telework. The relatively scant public administration research on this innovation and on its semantic or substantive variations such as telecommuting, home-work, remote work, and smart work has examined its effects on teleworkers and only recently on non-teleworkers. However, scholars have overlooked the relational dynamics triggered by telework. This is the focus of our study. We start by connecting telework with specific features of public bureaucracies, such as control, modularity, and the separation of professional and personal life. Next, we explore through a mixed-methods design a relational dynamic overlooked by previous studies, that is, the preferences of non-teleworkers towards teleworking colleagues and the motives behind them. Results from a discrete choice experiment with over 1,000 non-teleworking public employees revealed a remarkably strong preference toward non-teleworkers. A qualitative follow-up based on semi-structured interviews found the workplace collective as the locus of the tensions caused by telework and illuminated critical issues perceived by non-teleworkers, ensuring a more fine-grained understanding of the impacts of flexible work arrangements on the functioning of public organizations.

In the absence of widespread vaccination for COVID-19, governments and public health officials have advocated for the public to wear masks during the pandemic. The decision to wear a mask in public is likely affected by both beliefs about its efficacy and the prevalence of the behavior. Greater mask use in the community may encourage others to follow this norm, but it also creates an incentive for individuals to free ride on the protection afforded to them by others. We report the results of two vignette-based experiments conducted in the United States (n= 3,100) and Italy (n= 2,659) to examine the causal relationship between beliefs, social norms, and reported intentions to engage in mask promoting behavior. In both countries, survey respondents were quota sampled to be representative of the country’s population on key demographics. We find that providing information about how masks protect others increases the likelihood that someone would wear a mask or encourage others to do so in the United States, but not in Italy. There is no effect of providing information about how masks protect the wearer in either country. Additionally, greater mask use increases intentions to wear a mask and encourage someone else to wear theirs properly in both the United States and Italy. Thus, community mask use may be self-reinforcing.

BACKGROUND There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. OBJECTIVE The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. METHODS We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. RESULTS The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. CONCLUSIONS The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. CLINICALTRIAL ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135

Background There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135

While performance information is often used to communicate the importance of public policies and stimulate civic engagement, we know little about the processes that connect the two. This study proposes a conceptual model that links performance information to a specific form of public engagement ‐ coproduction. Drawing on insights from information aversion theory, we argue that the effect of performance information on engagement in coproduction depends on levels of policy understanding and the valence of performance information individuals are exposed to. Specifically, we predict individuals exposed to positive performance information will understand the policy better than those exposed to negative performance information. Further, we predict higher levels of policy understanding will increase coproduction engagement intentions. These predictions are examined using two experiments and a representative sample of US residents (n=836). Findings indicate participants best understood positive information and that understanding significantly increased coproduction engagement intentions.

UNSTRUCTURED A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.

Building on Cognitive Load Theory and the Elaboration Likelihood Model of Persuasion this study attempts to deepen our understanding of how health information campaigns related to vaccination work. We predict that including statistical information in health information campaigns will serve as a distraction that suppresses comprehension that renders the campaign less effective at persuading the public to vaccinate. Results from a survey experiment conducted on samples of US (n = 605) and Italian parents (n = 505) show support for the hypothesized relationship depends upon the form of comprehension (comprehension of how vaccines work versus comprehension of potential adverse effects of vaccinating). Specifically, both US and Italian parents show including statistical information reduces comprehension of how vaccines work, in turn reducing parents’ intentions to vaccinate themselves and their children. We find no support for the hypothesized mechanism when comprehension of potential adverse effects of vaccinating acts as the process variable.

Open government initiatives attempt to strengthen the relationship between public information disclosure and citizen engagement. Yet empirical assessments suggest they frequently miss their mark, thus highlighting a gap in open government knowledge: while a strong emphasis is placed on institutions in shaping the flow of government information and creating opportunities for engagement, there has been very little emphasis on understanding citizens and ways of communicating government information to draw them to engagement opportunities. To address this gap, we design a randomized survey experiment to demonstrate how the choice of reference points – cognitive anchors that innately influence the way individuals approach decisions – used to communicate government information can strengthen the relationship between public information disclosure and citizen engagement, and in turn the effectiveness of open government initiatives. We explain how these findings offer novel theoretical and practical insights into ways open government could be leveraged for purposes of enhancing citizen engagement.

A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.

In this paper, we use a design science approach to develop a mobile app for lung cancer patients that facilitates their interactions with their clinicians, manages and reports on their health status, and provides them access to medical information/education. This paper contributes to the information systems literature by demonstrating the value of design science research to co-create solutions that advance health care outcomes through technological innovations. The design process engaged a diverse cast of experts and methods, such as a survey of oncologists and cancer patients, a workshop, roundtables and interviews with leading patient and clinician association representatives and focus groups, including two panels each of clinicians and cancer patients. Our approach also develops actionable knowledge that is grounded in evidence from the field, including design guidelines that recapitulate what we learned from the design-testing-redesign cycles of our artefact.

Vaccine hesitancy has been on the rise throughout much of the world for the past two decades. At the same time, existing pro-vaccination public health communication strategies have proven ineffective. We present a novel approach to increase vaccination intentions, which appeals to individuals' other-regarding preferences. Specifically, we assess how vaccination intentions are influenced by the presence of people who cannot vaccinate, such as the immunosuppressed, newborns or pregnant women, using a game where there is a passive player whose welfare depends on the decisions of other, active players. Results from a survey experiment targeting parents and from a laboratory experiment provide support for a twofold positive effect of the presence of the passive player on vaccination intentions. These findings suggest messages that invoke altruistic, other-regarding preferences may be an effective approach to increasing vaccination intentions. Our findings could be extended to other campaigns where the population is invited to adopt behaviors that can help the most susceptible people, as is the case of the self-quarantine measures adopted during the outbreak of CoVID-19 at the beginning of 2020. If the attention of people is focused on the positive effect that they can have on those that cannot protect themselves, then the message may be more effective and people may be more responsive.

BACKGROUND Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. OBJECTIVE This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. METHODS Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. RESULTS A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. CONCLUSIONS mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement.

IntroductionMobile health technologies may enhance patient empowerment and data integration along the whole care continuum. However, these interventions pose relatively new regulatory, organisational and technological challenges that limit appropriate evaluation. Lung Cancer App (LuCApp) is a mobile application developed by researchers and clinicians to promote real-time monitoring and management of patients’ symptoms. This protocol illustrates a clinical trial designed to evaluate the usability, effectiveness and cost-effectiveness of LuCApp versus standard of care.Methods and analysisThis is a 24-week two-arm non-blinded multicentre parallel randomised controlled trial. A total of 120 adult patients diagnosed with small or non-small cell lung cancer and eligible for pharmaceutical treatments will be allocated 1:1 to receiving either standard care or LuCApp in addition to standard care at three oncology sites in Northern Italy. During the treatment period, LuCApp allows daily monitoring and grading of a list of symptoms, which trigger alerts to the physicians in case predefined severity thresholds are met. Patients will complete a baseline assessment and a set of valid and reliable patient-reported outcome measures every 3±1 weeks, and up to 24 weeks. The primary outcome is the change in the score of the Trial Outcome Index in the Functional Assessment of Cancer Therapy (Lung) questionnaire from baseline to 12 weeks. Secondary outcomes are the Lung Cancer Subscale, the EuroQoL 5D-5L questionnaire, the Hospital Anxiety and Depression Scale, the Supportive Care Needs Survey Short Form, the app usability questionnaire and the Zarit Burden Interview for the main caregiver.Ethics and disseminationThe trial received ethical approval from the three clinical sites. Trial results will be disseminated through peer-reviewed publications and conference presentations.ConclusionsThis trial makes a timely contribution to test a mobile application designed to improve the quality of life and delivery of care for patients with lung cancer.Trial registration numberNCT03512015; Pre-results.

Background Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. Objective This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement.

Recently, most reforms affecting healthcare systems have focused on improving the quality of care and containing costs. This has led many scholars to advocate the adoption of Health Information systems, especially electronic medical records, by highlighting their potential benefits. This study is based on a comparative analysis using a multiple method approach to examine the implementation of the same electronic medical record system at two different hospitals. Its findings offer insights into the processes of the adoption of innovation and its implementation in a healthcare context. The need to innovate, the decision to innovate, the implementation process and consequently, the results produced are quite distinctive at each study site. This comparative case study reveals that what appears to be the same can be quite different: this can be due to several conditions at the organization, the organization’s characteristics, and the process of implementation adopted. We need to understand these elements in order to be able to plan and manage such programs in the future.

Innovation promises to produce beneficial results for the most part. Consequently, there has been a great deal of discussion in management literature by academics and practitioners in recent years as to the impacts of innovation, on account of the extensive adoption of innovation in the public sector. The debate is currently open on multiple levels: the return of investment after the adoption of innovation, its contribution to the transformation of public sector organizations, and its impacts on society. The purpose of this chapter, based on a systematic review of literature, is to: discuss the status and trends in measuring innovation impacts; present cases and experiences; and set the basis for drafting a road map for moving forward in this field.

Voluntary policy compliance is an important yet rarely studied topic in public administration. To address the paucity of research, this article proposes and empirically tests a conceptual framework that ties policy transparency and policy understanding to voluntary policy compliance intentions. The reasoning is that the extent to which citizens understand a policy contributes to their intentions to comply with that policy. Further, the authors argue that policy transparency indirectly influences voluntary policy compliance intentions through a positive effect on citizens’ levels of policy understanding. To enhance the validity of the findings, the authors assess these relationships across two policy domains. The findings reflect an indirect positive effect of transparency on voluntary compliance occurring through policy understanding. However, this emerged only for one policy domain. These results suggest that the effects of policy transparency on policy understanding and voluntary policy compliance intentions may depend on the policy domain.

While transparency is viewed as a means of improving citizen understanding of public policies and eliciting policy support, there are few empirical assessments of these relationships. We address this gap in the literature using an experimental design. We predict that exposure to less detailed policy information improves policy understanding, and that this effect varies according to presentation format. Further, we predict that policy understanding will correspond to greater policy support. Using a nationally representative panel of US citizens we find that exposure to detailed policy information decreases policy understanding and that the effect varies by presentation format. In addition, policy understanding is negatively associated with policy support. These findings culminate in a positive indirect effect—increasing detail reduces understanding, which in turn is negatively associated with policy support. However, interestingly, policy support was highest among those who felt they understood the policy best, yet possessed the lowest levels of actual understanding.

Il Fascicolo Sanitario Elettronico (FSE) rappresenta un’innovazione complessa che interessa molteplici attori con interessi e prerogative diverse. Partendo da una breve sintesi delle evidenze emerse dalla letteratura sui fattori che ne determinano l’adozione e ne influenzano l’implementazione, l’articolo si focalizza su un fattore particolarmente rilevante rispetto ai diversi attori coinvolti nell’implementazione del FSE, cioe la governance e i diversi modelli attraverso cui essa si esplica. Oltre a delineare i principali contributi teorici emersi dalla letteratura, l’articolo analizza il modello di governance adottato nel caso della Regione Veneto, che si contraddistingue per le forti prerogative delle aziende in materia di innovazione. Alla luce della letteratura e del caso della Regione Veneto, si riportano alcune conclusioni rispetto alla governance del FSE.

Assessing impacts related to the adoption of an innovation represents a particular challenge. However, the use of innovation in government organizations does have some effects: some intended, others unintended; some desirable, others undesirable. Findings in literature now suggest that the use of innovation in government organizations produces beneficial results for the most part. The purpose of this article is to provide a multi-dimensional framework for assessing the impacts of innovation on an organization’s performance as perceived by individual stakeholders and at organizational level. In particular, this framework is designed to evaluate the impacts resulting from the introduction of electronic medical records, namely an organizational, cultural, and technological innovation that many health care providers are currently undertaking. It provides the results of a comparative analysis carried out in Spain and Italy and discusses the need for a more systematic evaluation assessment of the innovation pro...

This study examines the impact of policy transparency on citizens’ levels of policy understanding and support for a hypothetical policy. Specifically, we propose that the effects of transparency on understanding are heavily contingent upon the way government information is presented. Further, we suggest that greater policy understanding will be associated with higher levels of policy support. We examine these relationships using a survey experiment that draws upon a nationally representative panel of citizens. The results demonstrate that effects of policy transparency on policy understanding are heavily contingent upon presentation – participants exposed to more detailed information about the policy understood the policy worse than those exposed to less detailed information. In turn, objective levels of understanding are associated with lower levels of policy support. As such, our findings suggest the presence of a positive indirect effect of policy transparency on policy support. Our study also shows that an individual’s sense of understanding predicts greater policy support among citizens with a poor objective understanding of the policy. Implications for theory and research are discussed.

BackgroundSince the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. ObjectiveThis paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. MethodsWe carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. ResultsOur analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. ConclusionsFurther research should start by stating and explaining what is meant by the evaluation of mHealth’s performance and then conduct more in-depth analysis in order to create shared frameworks to specifically identify the different dimensions of mHealth’s performance.

Any information disclosed by governments should serve the purpose it is meant to fulfill. This is an underlying pillar of transparency. Our article assesses whether the information citizens consider to be most relevant for interaction with the authorities is actually disclosed. Our research was conducted on the population of the 117 Italian provincial capitals. A sample of 500 Italian citizens were interviewed with the purpose of understanding which type of information they consider most relevant, given the choice of institutional, political, financial, and service delivery–related information. The results indicate that Italian provincial capitals currently fail to publish the information that citizens consider to be most relevant: Despite differences in opinions among users, the sample we analyzed tends to rate the importance of service-delivery transparency and financial transparency higher than institutional or political transparency, whereas most information disclosed by Italian provincial capitals is associated with data they are obliged to disclose in order to comply with transparency regulations.

Coordination is a central element in the public sector, especially for introducing complex innovations. In health care, this issue takes on great importance since many stakeholders are involved, pursuing multiple interests, and influencing the outputs and outcomes of the health care system. This paper discusses the introduction of a specific health care innovation (i.e. electronic patient records) in two Italian regions, and it aims to contribute to the debate on coordination in health care, depicting the coordination mechanisms that took place in two different contexts in order to introduce the same kind of innovation, and highlighting any potential enabling conditions.

BackgroundRecent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context.MethodsCase study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT.ResultsQualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central ‘actor’ within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal.ConclusionsThe paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.