The rise and fall(acy) of clinical directorates in Italy.

Clinical Directorates (CDs), in the sense of "intermediate organizational arrangements through which defined parts of larger hospitals health services are managed", were introduced in the Italian National Health Service (INHS) by law after the major reform of 1992. By means of such reform, accountability chains within INHS hospitals were streamlined. Changes looked at strengthening the role of management in hospitals as a strategy to improve efficiency in the provision of services. From this stream of managerialism emerged the attempts to re-organize hospital activities along the lines of clinical directorates. The aim of this paper is to outline the context in which CDs initially developed in Italy as the "one best way" to address current hospital problems and the reasons why they are now challenged due to not coming up to expectations. To do so we run through the last 10 years of history of CDs in Italy and propose an interpretative framework to understand the grounds for their partial failure and success.