From Volume to Value: The Strategic Role of People Management in the Value Health System

Abstract

Introduction. The Italian National Health Service is facing two closely connected challenges: the growing shortage of healthcare professionals and the financial sustainability of the system. Difficulties in recruiting and retaining personnel are affecting service delivery, while several Regions struggle to maintain balanced budgets or provide adequate levels of care. Cost-containment policies have primarily focused on controlling consumption and reducing procurement prices, particularly for pharmaceuticals and medical devices. However, the actual use of resources for individual clinical cases and within operational processes remains insufficiently understood. This conceptual contribution examines how granular process knowledge and strategic people management can support the transition from a volume-oriented system to a value-oriented health system.

Methods. A conceptual health-policy and organizational analysis was undertaken, considering existing expenditure-control mechanisms and the macro-level monitoring activities performed by the Court of Auditors, the Ministry of Health, and Agenas. The analysis explored the relationships among workforce shortages, financial sustainability, internal process knowledge, resource allocation, and public value creation.

Results. Existing control mechanisms enable the monitoring of aggregate expenditure and financial balance but provide limited insight into resource utilization and internal processes at the individual clinical-case level. This creates a substantial gap between perceived and actual costs and organizational inefficiencies. A value-oriented system requires a granular understanding of operational processes, much of which resides with healthcare professionals. Collaboration between economic-managerial and clinical-organizational expertise can support the identification of inefficiencies and the more effective reallocation of resources. Nurses and other healthcare professionals consequently assume a strategic role not only as care providers but also as contributors to process governance and public value generation.

Discussion. Strategic people management can enable a structural transition from indiscriminate cost reduction to the qualification of healthcare expenditure. Involving healthcare professionals in process analysis, organizational decision-making, and resource allocation can improve efficiency while maximizing the impact of available resources on population health. Recognizing nurses and other healthcare professionals as active participants in value creation is therefore essential for the sustainability and organizational resilience of the Italian National Health Service.