Making performance measurement effective: from Knaves to Knights through the managerial approach

Mariani Laura, Tieghi Marco


In healthcare the concept of value have been defined in different ways, however most commonly this involves the degree to which services are delivered effectively (higher quality) and efficiently (lower total cost of care). Health policies, mirroring this perspective, aim both at controlling public expenses, and at improving the quality of care, often through the development of frameworks for performance measurement (PM). Through PM frameworks, policy-makers set performance indicators and the associated targets for the achievement of healthcare improvement goals, and this allows the definition and setting of priorities, it expresses a commitment to achieve specified objective in a defined period, and it helps to monitor their progress (Smith et al 2009). This implies that the frameworks of PM are effective when they are able to promote the implementation of health policies, creating high-level political and administrative commitment to particular results, and providing a basis for follow up and evaluation (Smith et al 2009). However, a large part of literature demonstrates that healthcare organizations and professionals perceived the evaluation process as an exogenous, time-consuming, and potentially damaging exercise, and they often react through gaming behaviours, compromising the performance measurement effectiveness. The aim of this short paper is to contribute to the debate on the effective design and implementation of performance measurement system at governance level, with a specific focus on the healthcare sector. In particular, we propose a theoretical interpretation of the barriers affecting such initiatives – namely the implicit adoption of the agency theory assumptions –, and we propose the adoption of the pragmatic approach of management studies to overcome these obstacles. […]

Key-Words: Misurazione e valutazione delle performance