Chronic disease management in the Lombardy region: An evolutionary service network perspective

This paper fits into the theoretical framework of service networks. Its aim is to understand service network change meaning, characteristics and connections with extant literature and to investigate how a service network can change in a specific context, a regulated sector. The regulated service network considered is the Italian health care network. A theoretical framework guided the analysis to explore how the actors' perceptions evolved during specific time, space, and relationship dimensions in terms of what, why and where changes happened, happen or will happen. A pilot project, still on-going, is the longitudinal case study analyzed. Introduced at a territorial level by an institutional actor in 2011, the project aims at re-engineering the network service provided to chronic patient category, focusing the network supply on a specific actor, the General Practitioners. The paper illustrates how involving/enhancing the role of each actor in a new network configuration makes it possible to generate dynamics and produce evolutionary processes co-created and shared between the involved actors. Service networks need orchestration, beginning with the actors most involved in the process of change, the focal actors, by co-opting them, including existing resources and new partners, exploiting the users' contributions to recreate the service network, and cooperating with external partners. As a consequence, innovation in service networks can derive from the action of single/group of actors who understand the need for improvements and activate themselves to drive that change. This consideration seems to be particularly relevant when the speed of changes is restrained as often happens in regulated sectors. (C) 2013 The Author. Published by Elsevier Inc. All rights reserved.