Interactive management control via analytic hierarchy process (AHP). An empirical study in a public university hospital

Management control in public university hospitals is a challenging task because of continuous changes due to external pressures (e.g. economic pressures, stakeholder focuses and scientific progress) and internal complexities (top management turnover, shared leadership, technological evolution, and researcher oriented mission). Interactive budgeting contributed to improving vertical and horizontal communication between hospital and stakeholders and between different organizational levels. This paper describes an application of Analytic Hierarchy Process (AHP) to enhance interactive budgeting in one of the biggest public university hospital in Italy. AHP improved budget allocation facilitating elicitation and formalization of units' needs. Furthermore, AHP facilitated vertical communication among manager and stakeholders, as it allowed multilevel hierarchical representation of hospital needs, and horizontal communication among staff of the same hospital, as it allowed units' need prioritization and standardization, with a scientific multi-criteria approach, without using complex mathematics. Finally, AHP allowed traceability of a complex decision making processes (as budget allocation), this aspect being of paramount importance in public sectors, where managers are called to respond to many different stakeholders about their choices.

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

Introduction
Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.

Methods
The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.

Discussion
This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.