Performance Management in Healthcare

The relevance of the efficiency and the interest about the performance management in the public sector, has been highlighted by the New Public Management. Starting from 1980’, public organizations started to put more attention to the performance management and evaluation. A fundamental aspect is to underline the main role of the measurement of performance. Studies in performance measurement have shown that, thanks to an appropriate measurement and management of performance, organizations can have different benefits, in terms of formulation and implementation of organizational strategy, communication of the results achieved and motivation of employees (P. Micheli & Mari, 2014).With reference to the way in which the public organizations should measure their performance, there are many studies about this topic (Elg. et al, 2013). Del Bene (2014) affirmed that the system used to measure and evaluate performance must be conceptually, theoretically and empirically coherent. R.S. Kaplan and Norton (1992) consider that measures should be derived from strategy and represent different dimensions of an organization. In the public healthcare sector, the relevance of performance measurement is justified by the fact that health care organizations have a fundamental impact on the individuals’ life, thus, measuring the way in which these organizations work is fundamental to judge if they are effective and efficient. Currently, there is a higher interest in measuring and reporting performance in this sector, and in some cases there is the problem of having too many measure (Cassel et al., 2014). With reference to the performance management aspect in the Italian Health system, there is not a general model used by all the organizations to measure and manage their performance. Starting from these aspects the first research questions analyzed are: RQ1 “How do Italian healthcare organizations define Organizational Performance?” and RQ2 “Is Organizational Performance measured by Italian healthcare organizations, and if so, how?” In the literature there are some papers that study organizational performance measurement system at regional and national level, as in Italy (Giovanelli et al., 2015; Nuti, Seghieri, & Vainieri, 2013; Nuti, Seghieri, Vainieri, & Zett, 2012; Vittadini, 2012) as in other countries (P.C. Smith, 2002), but there is a lack with reference to the specific way in which each Italian public healthcare organizations measure their organizational performance. To this extent a third and fourth research questions have been analyzed: RQ3 “How do Italian public healthcare organizations measure their organizational performance?” and RQ4 “What are the factors that influence the design of performance measurement systems?” The Italian healthcare service is based on a solidarity approach, according to which all citizens have free access to a set of medical treatments, regardless of personal income or geographical distribution. This approach requires a high level of resources and health spending in Italy at national level is about 9.1% of GDP in 2015, in line with the OECD average (9%) and it is mainly public (77%, vs 73% of the OECD average) (OECD, 2015). To continue the previous researches, an analysis, to observe the presence of connections between performance achieved by Italian public health-care organizations at regional level and the changes in expenditure, will done. In particular, the study started from one research question: RQ5 “Is performance in universal health care provision influenced by changes in public expenditure?” This is the last research questions of this thesis.