Featured case: The Set-up of Fast Track Surgery in Vascular
Surgery: The Experience of a Pioneer Team in Northern Italy

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The case

Who – the protagonist


Dr Claudio Gualtieri, General Director of Novara teaching hospital, and Dr Piero Brustia, Vice-Chief of the hospital’s surgery department.


The hospital is based in the city of Novara (also the same name as the province is part of) in northern Italy.

The Regional Health Department’s ambition was to increase the hospital’s volume of activities and make it the cornerstone of acute care in the province, as the other five hospitals were designed for low intensive care and rehabilitation.

Dr Gualtieri was tasked with making this happen, and he believed Dr Brustia’s method of fast track surgery could be key.


Dr Gualtieri was new to the region and lacked the required overall knowledge of the organisation to compile a fresh strategy development.

He targeted the surgery department as the pilot for testing the change management and rationing processes required, to become the hub of surgery activities in the province.

Dr Gualtieri met with Dr Brustia and the latter pointed to data underlining how his team’s fast track surgery, which was restricted to vascular unit operations, led to a sharp increase of people treated, whilst reducing the number of beds from 16 to 12.

Impressed by the numbers, Dr Gualtieri was interested in rolling this approach out to all types of surgery at the hospital.


Dr Gualtieri was appointed to the role of General Director in April 2015.

Dr Brustia joined the hospital in 2003, initially heading up the vascular surgery unit. The unit’s report gathered information from 2003 to 2014, which Dr Gualtieri used to assess the merits of fast track surgery.

The fast track surgery method was first explored in Italy in the late 1990s, with Dr Brustia part of that process.


The city of Novara, located on an important commercial route for traffic between Milan and Turin, sits in the Piedmont region, which borders France and Switzerland.

Novara, home to approximately 105,000 inhabitants, is the second city of Piedmont.

Key quote

“Whereas we had favourable achievements proving the success of the fast track, it rose too many issues at the organisation and political levels, squeezing our visionary programme.” – Dr Brustia telling Dr Gualtieri of his frustrations at the previous hospital he was based at the nearby town of Biella.

What next?


After his meeting with Dr Brustia and the analysis he provided, Dr Gualtieri contemplated how to improve the surgery department using the fast track model.

Whilst Dr Gualtieri could see fast track surgery had the potential to meet his target of increasing the hospital’s volume of activities, the small-scale experience of the vascular surgery unit under Dr Brustia posed many challenges.

Not least the required hard work to engage professionals and finding the right leadership to hold everything together.

In addition, the start-up costs were high in terms of training and recruitment, but Dr Gualtieri was assigned no extraordinary funds for extraordinary cases – and this most certainly was one.
The authors


Verdiana Morando and Valeria Tozzi

The case was written by Verdiana Morando, under the supervision of Valeria Tozzi, with the support of a case writing scholarship from The Case Centre.

Pulling in different directions

Verdiana said: “This case is really interesting as Dr Brustia’s fast-track surgery is an exciting and innovative method, but hospitals are complex organisations, with many different departments and layers of authority, so there’s varying views on the best way forward as a body.

“The case therefore provides students with the ideal opportunity to analyse different perspectives and provide alternatives or solutions.”

Learning from the case

Elderly handsValeria continued: “As well as appealing to students in postgraduate courses in management and organisational courses and similar executive programmes, the case can be applied to professionals working in public sectors in the healthcare sector.

“It’s important that the people who are involved in the day-to-day running of hospitals and different care sectors, whether that would be a clinician or social worker, can learn from materials such as this case study.”


Verdiana added: “An important learning objective this case provides relates to the evaluation of leadership.

“Students are able to analyse the leadership approach of Dr Brustia – and how this has evolved from the various hospitals he has worked at – compared to those of the other professionals who have joined his team, as followers, and how leading change can be achieved in different ways.”

Nurturing the case discussion

Valeria concluded: “To ensure the case has the maximum impact in the classroom, three frameworks need to be considered.

“This encompasses the notion of organisational learning, how to develop and apply innovation and the role of leadership and innovation in complex and highly specialised environments.”

About the authors

Verdiana Morando is a Research Fellow at Università Bocconi’s Cergas Research Centre.
e verdiana.morando@unibocconi.it  
tw @VerdianaMorando

Valeria Tozzi is Director of the Master in Management for Healthcare at Università Bocconi.
e valeria.tozzi@unibocconi.it

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The Set-up of Fast Track Surgery in Vascular Surgery: The Experience of a Pioneer Team in Northern Italy
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Teaching note
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This case was written with the support of a case writing scholarship from The Case Centre.


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