Managing variety in healthcare through personalized medication: the contribution of 3D-printing technologies

Among the numerous humankind problems, healthcare represents a key issue to manage. Various managing systems are implemented reflecting different views, approaches and the socio-economic conditions of the country (Glouberman and Mintzberg, 1996; Plsek & Wilson, 2001; Wendt, 2009; Swayne et al., 2012). However, a fundamental problem affects almost every healthcare system: managing the trade-off between the need to deliver effective healthcare services and the need to control expenses and to ensure the overall sustainability of the system (France et al., 2005). This problem is an expression of the complexity of healthcare systems. Healthcare systems, in fact, have been studied as complex adaptive systems whose management is required to adopt an adaptive approach based on incentives and inhibitions instead of command and control (Rouse, 2008). Despite the massive organizational efforts, healthcare processes are hard to be effectively designed, controlled and, most of all, optimized. Decision makers have to manage high levels of variety and variability (Espejo, 1994; 2015a, 2015b; Blecker and Abdelkafi, 2006; Gershenson, 2015), taking into account not only the irreducible information asymmetry in the relationship with patients/users (Bloom et al., 2008; Barile et al., 2014, 2015) but also the diverging interests and needs that characterize actors involved in the healthcare systems dynamics, starting from the private and public ones (Savas & Savas, 2000; Barlow et al., 2013; Saviano et al., 2014). In the Italian healthcare system, like in many others, the need to control expenses and to ensure the sustainability of the system has lead to the introduction of the economic logic of management (France et al., 2005; Anessi‐Pessina and Cantù, 2006; Borgonovi et al., 2008). This logic, however, has been mainly interpreted in terms of cutting expenses instead of improving efficiency, reducing waste, etc., so ending up for reducing the level of service offered (e.g. number hospital beds, days of hospitalization for surgery, number of expensive new drugs provided by NHSs etc.). To improve efficiency, instead, the managerial logic has oriented towards the standardization of processes by introducing the use of protocols, standards, etc. in the service delivery. The definition of protocols and standards is expected to find the ‘best way’ to implement processes (Kongstvedt, 2001). Although conceived to widely ensure a standard level of quality of service, the standardization of healthcare does not imply improvements of the effectiveness of service.