title: Reorganising hospitals to implement a patient-centered model of care: Effects on clinical practice and professional relationships in the Italian NHS.
abstract: OBJECTIVE
  The purpose of this paper is to understand how the introduction of a patient-centered model (PCM) in Italian hospitals affects the pre-existent configuration of clinical work and interacts with established intra/inter-professional relationships.
  
  
  METHODS
  Qualitative multi-phase study based on three main sources: health policy analysis, an exploratory interview study with senior managers of eight Italian hospitals implementing the PCM, and an in-depth case study that involved managerial and clinical staff of one Italian hospital implementing the PCM.
  
  
  RESULTS
  The introduction of the PCM challenges clinical work and professional relationships, but such challenges are interpreted differently by the organisational actors involved, thus giving rise to two different "narratives of change". The "political narrative" (the views conveyed by formal policies and senior managers) focuses on the power shifts and conflict between nurses and doctors, while the "workplace narrative" (the experiences of frontline clinicians) emphasises the problems linked to the disruption of previous discipline-based inter-professional groups.
  
  
  CONCLUSIONS
  Medical disciplines, rather than professional groupings, are the main source of identification of doctors and nurses, and represent a crucial aspect of clinicians' professional identity. Although the need for collaboration among medical disciplines is acknowledged, creating multi-disciplinary groups in practice requires the sustaining of new aggregators and binding forces.
  
  
  CONCLUSIONS
  This study suggests further acknowledgment of the inherent complexity of the political and workplace narratives of change rather than interpreting them as the signal of irreconcilable perspectives between managers and clinicians. By addressing the specific issues regarding which the political and workplace narratives clash, relationship of trust may be developed through which problems can be identified, mutually acknowledged, articulated, and solved.
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy.
authors.forename: Elisa Giulia
authors.initials: EG
authors.lastname: Liberati
authors.forename: Mara
authors.initials: M
authors.lastname: Gorli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaratti
mesh_terms: D004059:Diffusion of Innovation; D006302:Health Services Research; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D018802:Patient-Centered Care; D036301:Qualitative Research; D013222:State Medicine
keywords: Hospitals; Medical professions; Organisational innovation; Patient-centered care; Roles