Planning, budgeting and control systems, and management strategies of inputs in lean hospitals: literature review and potentialities of HTA

Bert Fabrizio


Background: In recent years, the major organizational changes in healthcare took place in the hospital setting through the progressive adoption of the lean hospitals. A similar evolution requires a redefinition of the planning, budgeting and control systems. Then, we aim to review the scientific literature regarding the planning, budgeting and control systems and management strategies of inputs in hospitals with intensity of care organization. Our secondary outcome was to prearrange a Health Technology Assessment concerning organizational and reorganizational processes in the Italian setting.

Methods: We conducted a review, using four databases, regarding processes and pathways-based systems of planning, control and management. The search was completed using a snowball strategy and through reference list screening.

Results: We included in the review 11 studies. The main strategies of analysis emerging from our review were Activity Based Costing (ABC) and its revised forms including Simplified-Activity Based Costing (S-ABC), Time-Driven Activity Based Costing (TDABC), and Activity Based Management (ABM). Furthermore, the analysis outlined that most of the reorganizational experiences retrieved were only partial, not completely replacing the previous organizational approaches. The Health Technology Assessment design was widened through some Italian experiences. However, data regarding national experiences appeared scarce. 

Discussion: Considering the paucity of available data regarding process-based analysis in intensity of care reorganization, further studies with rigorous and multidisciplinary approach are required. However, a key element was the importance of aligning the new organizational structures to innovative planning, budgeting and control systems. In this framework, the Health Technology Assessment represents a useful tool for all hospitals projecting similar reorganizations.

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