Abstract
Change is a pivotal factor in any organization. Organizational change is a complex phenomenon where human dimension is primary criticality to be managed. Change-related expectations (Portoghese et al, 2011), understanding (Pomare et al, 2019) of and commitment to change actions are key inputs to impede failure of re-organizational path. On the other hand, to be competitive within external environment, alignment of organizations outcomes should be continuously pursued. Therefore, organisational change also requires an external impact perspective. To detect the most relevant trends in literature on organizational change issue, a quantitative-based method, called "Systematic Literature Network Analysis" (SLNA) (Colicchia & Strozzi, 2012), employing jointly systematic literature review and bibliometric network analysis, was adopted to perform a literature review on the topic. The bibliometric network showed 1284 documents out of 1968 that received at least one citation; secondarily, the analysis revealed that 840 out of 1284 documents were connected. Within the network, Citation Network Analysis (CNA) allowed for extracting main path in the development of research's contents, starting from the biggest connected component composed of 353 works. Co-occurrence keywords analysis identified 8 clusters of contributions previously excluded as not having received citations nor having cited other authors' papers. Works reviewed pointed out a convergence on the micro-level perspective for change's analysis, albeit an organic viewpoint whereby individual, organization and change's outcome contribute to any organizational change's action is in its early stage. Contributions have been limited within healthcare context. 5 Interestingly, change has been combined with innovation, although the structure of the relationship has not outlined. Over years, healthcare organizations have been exposed to multiple external stimuli to change (eg aging population, increasing incidence of chronic diseases, ongoing Sars-Cov-2 pandemic) that pointed out the need to convert current healthcare organizational model. Innovation is "one of the liveliest issues" (Ciasullo et al., 2017) in healthcare. Pace of healthcare innovations upcoming to market is rapidly increasing; innovations are contributing to reshape the way healthcare organizations deliver services and are enhancing incrementally patients' health-related outcomes. Physicians are primary "end-points" of innovation's adoption, exerting the role of "gatekeepers" in selecting which innovation has to be administered for meeting the clinical needs demanded by the patient. On the other hand, however, physicians tend to hamper organizational change initiatives impacting on their daily clinical routines. Understanding organizational change-innovation relationship deserves interest in healthcare field. Since individual change acceptance is gaining ground as dimension of analysis, delving into the factors explaining clinicians' attitude towards innovations or more broadly the acceptance of changing in healthcare is the scope of the present thesis. Preliminary, to get insights on how healthcare professionals react to an innovation built "from the ground up", a fuzzy logic algorithm has been developed to mimic radiologists' reasoning in choosing the proper level of contrast medium to be administered to patients affected with mild and moderate renal impairment. This primary step of the thesis contributed to pinpoint the degree to which such a technological innovation may found applicability in clinical practice, either as clinicians' decision on making use of innovation (Frambach & Schillewaert, 2002), namely its adoption, either as critical factors influencing algorithm's performance. "Outer" innovations have been the focus of the present thesis. Two innovations, technology-based and non technology-based, have been chosen to be compared on the same target users, HIV specialists of Lombardy Region. 91 HIV specialists composed the sample of analysis. Hospitals comprised in the sample served a cohort of 26016 HIV patients in 2018 over 30100 in the same year. 6 Among existing models focusing on individuals' attitude, rooted in the "Theory of Planned Behaviour" (TPB) (Ajzen, 1991), only "Technology Acceptance Model" (TAM) (Davis, 1989) supplemented technology characteristics (Jen, 2009). In this view, TAM has been assumed to be an evaluative tool for both innovation and change's acceptance. Specifically, HIV specialists' acceptance of new HIV long-acting injectable regimen based on Cabotegravir (CAB) and Rilpivirine (RPV) has been investigated. The drug is not currently available; marketing authorization is ongoing. To date people living with HIV (PLWHIV) received daily oral pills as elective treatment to guarantee virological suppression, available directly at pharmacy of hospitals. Long-acting injectable regimen would require two intramuscular intakes every 60 days that will force specialists to schedule outpatients visits with timing and frequency constraints. HIV LA (CAB + RPV) ART is a point of discontinuity with the paradigm of care adopted to date by specialists. Patients affected with HIV have high expectations on the drug. An organizational innovation based on shared services model as Azienda Zero has been selected to get a fully understanding of innovation-change adoption issues. Over last years, Health Regional Services are experiencing a growing economic burden, even due to the health technologies spreading, that may create services inequalities. Accordingly, Italian Regions are setting up Regional Institutions in the wake of Mintzberg's technostructure, so that standardisation of purchasing, even of diagnostic and therapeutic pathway for HIV, is "outsourced" to the Region and hospital is assigned a service provision role. To assess the hypothesised path dependencies partial least squares structural equations modelling (PLS-SEM) (Lohmöller, 1989) has been performed in order to stress a casual predictive approach (Hair et al., 2018). PLS Confirmatory Factor Analysis (CFA) has been applied to assess measurement model. Convergent validity has been validated by four metrics (Items reliability [>0·708], Cronbach's alpha [>0·70], composite reliability [>0·85] and Average Variance Extracted (AVE) [> 0·50]); discriminant validity has been discussed with three criteria (Fornell and Locker criterion; cross-loadings of indicators; Heterotrait-monotrait ratio [HTMT < 0·90]). Structural model evaluation has been executed to assess theorized linkages and mediation effects; 7 in-sample predictive power has been ascertained by R squares; Stone-Geisser Q2 has been assumed also to be a proxy of out-of-sample predictive power. Findings revealed that two research trajectories are being developed within literature on change management. Individual awareness of change and layered viewpoint (micro-meso-macro) on organizational change actions represented the major results. Albeit healthcare organizations are "professionals-centered", those research routes have not been broadened, bounding the understanding of how professionalized organizations works. Fuzzy logic expert system experimented demonstrated that healthcare innovations supporting clinical-decision making should be explained to end-user to being fully endorsed. For pharmaceutical innovations, patients' benefit rules clinicians decision-making of innovation acceptance, although physicians weight the perceived "value" for patients with "costs" of organizational alignment of daily clinical routines. Trajectories of pharmaceutical innovations' development should account for secondary outcomes concerning organizational needs, as to meet properly the wholeness of expected physicians' goals. Organizational innovation based on shared service model (Azienda Zero) showed that policy makers should conceive health re-organizations in light of the health outcomes and not only of outputs (efficiency) to solicit physicians engagement to change. Ultimately, the change-innovation relationship investigated informed that in knowledge-based organisations, the clinician filters incoming innovations by making a judgement as to whether or not they are acceptable. The context of implementation may determine the failure of the innovation, making it unacceptable in the clinician's judgement, even if clinically valuable. Therefore, the role of physician is still the core component within the complex world of healthcare system.