Today, turnaround plans in Italy have been adopted by ten out of twenty-one regional health systems, predominantly in the South, and account for a cumulative deficit (2001-2010) of € 38 million. Moreover, decentralization of the care system together with the current financial-economic conditions make it highly probable that in the near future they could become ordinary planning tools. In the article in press in Health Policy (volume 106, 2012, doi: 10.1016/j.healthpol.2012.03.007), titled The Challenge and the Future of Health Care Turnaround Plans: Evidence from the Italian Experience, Francesca Ferrè and Federico Lega (Department of Policy Analysis and Public Management), with Corrado Cuccurullo (Seconda Università di Napoli), using semi-structured interviews to key stakeholders tested the level of effectiveness of recovery plans focusing their attention on three significant case-studies: Sicily, Campania and Lazio, which account for the highest cumulative deficit (€ 26 million).
Health care turnaround plans are institutionalized processes for recovery to reduce the financial instability of Italian regional health care systems. Central government conveyed the introduction of the turnaround strategy for deficit regions to increase efficiency and reduce deficit problems in the future. However, the effectiveness of this tool was widely questioned, and many critics suggested that it was focused more on methods to address short-term issues (recovery plans) than on structural determinants of the organisational failures and costs of the region (turnaround plan) that is required for regional health systems to ultimately address long-term system reconfiguration. Indeed, on the one hand, health care turnaround plans have facilitated the decrease of health expenditure across the regions, but on the other, they have not yet been adequately used to improve and stir action for change in the health care context. Thus, what are the discrepancies between the intrinsic aims of turnaround plans and their essence?
From the analysis carried out the prevailing perceptions about the limited effectiveness of the recovery plans were confirmed. Recovery plans seem to contain primarily “cosmetic” interventions driven by a lack of recognition of regional differences. The results from the semi-structured interviews also emphasise that the turnaround process was slow and inconsistent because coordination and control between the players involved in the process was tenuous and unsteady. A plurality of actors weakly engaged in the process were called upon to take action and facilitate the recovery strategy of failing regional health systems.
It clearly appears that turnaround plans were less effective in their implementation than expected. Especially the gap between contents and process implementation was recognized to be still ample; such a finding shows that the introduction of strategic management tools in the health care systems is still linked to a rather strong bureaucratic - normative paradigm.
From this qualitative analysis the authors propose nine recommendations for best practice in the use of turnaround plans to policy makers and managers working in the health care sector. In particular, they highlight the need for the creation of a strong and reliable information base; a punctual definition of assumptions and evidence; a detailed strategic analysis at the regional and local level; the definition of scenarios; a clear indication of the responsibility structure; the definition of action steps and an established timeframe; the inclusion of stakeholders; the development of knowledge transfer; the description of the level of alignment and degree of discretion between decision makers.