Operationalizing Proper Functioning of Performance Measurement Systems in the Italian Public Healthcare Sector

Abstract

Performance measurement systems (PMSs) have had an extraordinary diffusion over the last 20 years in Western countries' public sectors, although theoretical models and empirical studies on good practices, and metrics for effectiveness and impact are not very widespread. The aim of this paper is to propose a model for measuring the proper functioning of a PMS in the public sector through the selection of dimensions and indicators on the basis of the elements that literature believes to condition the use of performance data in management. Dimensions, indicators, and scores are validated through an exploratory trial of the model in the specific context of the Italian public health care system, with reference to the health managers' evaluation models. The empirical investigation is also used to identify and discuss potential determinants of good practices. In particular, in the context under investigation, size and economic performance are found to be significant drivers of proper functioning.Keywords: performance measurement systems (PMSs), proper functioning, healthcare sector, managers' evaluation models Performance measurement has been one of the main tools relied upon by the reforms of Western countries' public sectors, started in the 80s in the wake of New Public Management (NPM) (Walsh, 1995). Though the principles, models, and tools utilized in the diffusion of performance measurement in the public sector have varied, the primary purpose of such a system has always been seen as giving public managers useful information to improve services (Hatry, 2002). However, in order to meet both citizens' and funders' needs to be informed about the use of resources, achieving accountability has often been the real purpose for the development of result-based management systems in the public context. The major external impetus for performance measurement in the public sector is also testified to by policy-makers' common underestimation of the effort in developing accompanying mechanisms to enhance performance management, that can be