Weekend Mortality in an Italian Hospital: Immediate versus Delayed Bedside Critical Care Treatment

Background: a number of studies highlighted increased mortality associated with hospital admissions during weekends and holidays, the so–call “weekend effect”. In this retrospective study of mortality in an acute care public hospital in Italy between 2009 and 2015, we compared inpatient mortality before and after a major organizational change in 2012. The new model (Model 2) implied that the intensivist was available on call from outside the hospital during nighttime, weekends, and holidays. The previous model (Model 1) ensured the presence of the intensivist coordinating a Medical Emergency Team (MET) inside the hospital 24 h a day, 7 days a week. Methods: life status at discharge after 9298 and 8223 hospital admissions that occurred during two consecutive periods of 1185 days each (organizational Model 1 and 2), respectively, were classified into “discharged alive”, “deceased during nighttime–weekends–holidays” and “deceased during daytime-weekdays”. We estimated Relative Risk Ratios (RRR) for the associations between the organizational model and life status at discharge using multinomial logistic regression models adjusted for demographic and case-mix indicators, and timing of admission (nighttime–weekends–holidays vs. daytime-weekdays). Results: there were 802 and 840 deaths under Models 1 and 2, respectively. Total mortality was higher for hospital admissions under Model 2 compared to Model 1. Model 2 was associated with a significantly higher risk of death during nighttime–weekends–holidays (IRR: 1.38, 95% CI 1.20–1.59) compared to daytime–weekdays (RRR: 1.12, 95% CI 0.97–1.31) (p = 0.04). Respiratory diagnoses, in particular, acute and chronic respiratory failure (ICD 9 codes 510–519) were the leading causes of the mortality excess under Model 2. Conclusions: our data suggest that the immediate availability of an intensivist coordinating a MET 24 h, 7 days a week can result in a better prognosis of in-hospital emergencies compared to delayed consultation.

Different Ways of Viewing an Organization

From the industrial revolution to the present, scholars, consultants and experts in different disciplines have tried to answer the fundamental question: What is a business? In this chapter, we structure these historical perspectives in the following groups: Mechanical, Organic and Cultural. The mechanical perspective provides the “rational logic” of planning and supervision. The organic perspective adds creativity and initiative. Finally, the cultural perspective promotes internal unity through a common purpose that harnesses the commitment and engagement of the company’s members. From the combination of the three perspectives, we introduce the “Integrated Organizational Model” as the conceptual foundation of management by missions (MBM).

Quantitative Comparison between Traditional and Intensive Face-to-Face Education through an Organizational Model

Face-to-face education continues to present benefits in terms of student motivation, even though in COVID-19 scenario, online education has been the model of choice. In addition to the traditional face-to-face style, the intensive face-to-face style remains, which allows greater flexibility for the student. The objective of this study was to compare both educational styles and build an organizational model to improve student satisfaction. Two-way general linear model (GLM) with educational styles and satisfaction as fixed factors and discriminant analysis was applied. The selection of the most discriminant variables was made applying the F of Snedecor, Wilks’-Lambda, and the 1-Tolerance. A discriminant model was built. The four variables with the highest discriminant power were problem-solving communication with students’ representatives and shared knowledge and goals with lectures in the intensive style and frequent communication with administrative officers in the traditional style. In addition, it was found that greater face-to-face attendance did not imply greater coordination and that intensive style students show greater satisfaction. The appropriate duration of face-to-face education can contribute to the design of an innovative hybrid system in the future.

The League of Matteo Salvini: Fostering and Exporting a Modern Mass-Party Grounded on “Phygital” Activism

The Lega Nord (LN) has undergone a profound process of transformation since 2013, by replacing its historical regionalist populism with a new state-wide populist radical right outlook. However, very little is known about how such transformation impacted its organizational model, particularly the mass-party features that characterized it under its founding leader, Umberto Bossi. This article explores the organizational evolution of the party under Matteo Salvini by means of a qualitative in-depth analysis of 41 semi-structured interviews with representatives of the LN from four regions (Calabria, Emilia-Romagna, Lombardy, and Veneto) and primary documents. It underlines that the LN was turned into a disempowered and politically inactive “bad company,” charged with the task of paying the debts of the old party, while its structure, resources, and personnel were poured into a new state-wide organization called Lega per Salvini Premier (LSP). The LSP has not simply maintained the key features of the mass-party in the LN’s historical strongholds, but also pioneered a modern form of this organizational model grounded on the continuous interaction between digital and physical activism, i.e., “phygital activism,” which boosts the party’s ability to reach out to the electorate by delivering the image that the League is constantly on the ground. The LSP has sought to export this modern interpretation of the mass-party in the South; however, in that area its organizational development remains at an embryonic stage, and the party’s nationalization strategy has so far produced a “quasi-colonial” structure dominated by, and dependent on, the Northern elite.

The Communication Structure of the Government of Puerto Rico; Evolution and Challenges

The communication structure of a government is an area barely studied. This article intends to present academic perspectives to shape a structural organizational model of communication that is used as a reference in the evolutionary analysis of the communication of the Puerto Rico central government. It is concluded that the communication structure of the Government of Puerto Rico has presented significant structural modifications during six administrations that contain efficiencies, deficiencies and challenges for the management of its public communication.

Organizational Model for Pedagogical Practices of Informatics and IT

The article presents the current standards for pedagogical practices for the subjects Informatics and Informational Technologies for students in Sofia University “St. Kliment Ohridski” and the evaluation criteria for them. Some difficulties with online education due to the COVID-19 pandemics are noted. The author presents an organizational model for pedagogical practices of students in Informatics and Informational Technologies in which the trainees swap between primary and high school in the middle of their semester. The research is in pilot stage and presents results only from the author observations and non-formal interviews with students.

Innovative Clinical-Organizational Model to Ensure Appropriateness and Quality in the Management of Medical Cannabis: An Italian Regional Case

This work focuses on the clinical-organizational model implemented in an Italian region (Liguria) to streamline the access procedures to galenic cannabis preparations. The competent local health care authority that takes care of tracing a virtuous path to obtain common, uniform and shared protocols and ensure high standards of care is A.Li.Sa. (Azienda Ligure Sanitaria), a public organization with the function of coordination, direction and governance of the health care in the regional hospitals and health facilities. To this purpose, different working groups and a board meeting have been set up with the main role to define and develop technical standards to be applied to the prescription, preparation and dispensing of pharmaceutical forms based on therapeutic cannabis. In particular, the galenic preparations provided by the Italian Ministry of Health, described in detail in the regional standard operating protocols, are described and discussed. Moreover, the most significant data monitored from 2018 to 2020 and collected by hospitals and the evaluation of those derived from local pharmacies and health facilities are presented, discussed and compared in regards to their adherence and coherence with the Italian Institute of Health (ISS) data.

Digital Platform Ecosystems for Sustainable Innovation: Toward a New Meta-Organizational Model?

This work aims to develop a conceptual model to support countries, institutions, and firms toward the accomplishment of present Agenda 2030 sustainability goals. The last two decades have seen a growing interest in sustainability. Climate change, resource scarcity, multipolarity of interests, mistrust and delegitimization of institutions are just some of the critical issues that need to be addressed. There is broad consensus on the urgency of generating further social, environmental, and economic innovation to address these challenges, reshaping global markets, and offering new spaces of action to firms and institutions. Accordingly, there also is a wide search for new models of organizing firms. Digital platforms are among those. Moreover, since digital platforms require coordination among multiple actors and interests in order to succeed, they may also be conceptualized as meta-organizations, less hierarchical than firms yet more tightly coupled than markets. However, despite the wide literature on platforms, this organizational lens seems not to have been taken into the right consideration. This conceptual work aims to fill this gap, providing a framework that clarifies why and how a digital platform ecosystem could configure a sustainable meta-organizational model, and also providing the main steps to build it.