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.
Highlights
Since 80’s the introduction of New Public Managementprinciples has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector (Hood 1995; Lapsley 1999)
This paper reports the novel experience of the Tuscan performance evaluation system (PES); in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success
These aspects are highlighted by the debates that occur during public meetings where professionals speak about indicators in terms of colours and codes of indicators and say sentences such as ‘‘I am red in C5 while I am green in F15’’, which respectively mean that the Health Authorities (HAs) has a critical situation in the quality indicators while it has a good performance in the work safety prevention services
Summary
Since 80’s the introduction of New Public Managementprinciples has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector (Hood 1995; Lapsley 1999). Starting from 2008, the Tuscan PES framework has been adopted by other eight Italian regions as an internal evaluation tool and for external benchmarking purposes, and by the Ministry of Health, in order to monitor the uniform and essential levels of health services provided within the country (Nuti et al 2012). Given these premises, this paper reports the novel experience of the Tuscan PES; in particular, it assesses PES effectiveness and discusses the critical factors that could have led to the PES success. The outline of the paper is as follows: the second section describes the methodological aspects; the third section reports the making of the Tuscan PES, both the design and the implementation process; the fourth section sums up the first evidence of the PES effectiveness; the fifth one discusses the critical factors that could have led to success and the sixth one concludes
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