Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience

Abstract

Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare.

Performance Management Uses, Outcome Measures and Mechanisms-Based Explanations. The Case of the Judicial Sector

“…In fact, over the past decades, performance was mainly measured only in its financial dimension 26 A. Spano and A. Aroni (McCracken et al 2011) via "simple outcome-based financial indicators that are assumed to reflect the fulfillment of the economic goals of the firm" (Venkatram and Ramanujam 1986, p. 803). Most recent studies suggest a multidimensional approach to performance measurement considering the organization's strategies as well (Nuti et al 2013).…”

“…Since the advent of New Public Management (NPM) in the early 1990s, the issue of performance management has gathered increased attention (Bouckaert and Van Dooren 2009;Talbot 1999) and has become a fundamental issue for improving public services (Nuti et al 2013). One of the reasons for this increased attention is the fact that governments started to be accountable for the use of public resources and for the results achieved (Bouckaert and Halligan 2008).…”

“…In particular, they surveyed how Italian health care organizations measure their performance and observed the increased importance of the balanced scorecard that has been adapted to the features of the health care sector. In fact, even though financial indicators are still used-as in profit-oriented organizations-many nonfinancial indicators have taken center stage, and the balanced scorecard is useful to measure both financial and nonfinancial performance in health care organizations (Nuti et al 2013). Bocci (2005) proposed a new model of the balanced scorecard for health care organizations based on four perspectives (community, internal process, financial resources, and learning and growth).…”

“…This method is based on six evaluation dimensions (population health status, capacity to pursue regional strategies, clinical performance, patient satisfaction, staff satisfaction, efficiency, and financial performance) (Nuti et al 2013). For each dimension, a set of indicators is defined *130 indicators; the balanced scorecard approach is then used to evaluate OP.…”

“…In fact, over the past decades, performance was mainly measured only in its financial dimension 26 A. Spano and A. Aroni (McCracken et al 2011) via "simple outcome-based financial indicators that are assumed to reflect the fulfillment of the economic goals of the firm" (Venkatram and Ramanujam 1986, p. 803). Most recent studies suggest a multidimensional approach to performance measurement considering the organization's strategies as well (Nuti et al 2013).Since the advent of New Public Management (NPM) in the early 1990s, the issue of performance management has gathered increased attention (Bouckaert and Van Dooren 2009;Talbot 1999) and has become a fundamental issue for improving public services (Nuti et al 2013). One of the reasons for this increased attention is the fact that governments started to be accountable for the use of public resources and for the results achieved (Bouckaert and Halligan 2008).…”