MANAGING THE DIFFERENCES: A JOURNEY INTO THE MEASUREMENT OF PERFORMANCE PRACTICES IN THE ITALIAN HEALTHCARE SYSTEM

This thesis proposes a deep analysis of performance management in healthcare, focusing on the Italian NHS. The thesis has been developed to achieve three principal objectives. Firstly, it aims to propose an assessment of the current state of the art with regard to healthcare performance management in Italy, whilst also drawing comparisons with international evidence. The second objective of the manuscript is to induce deep reflections on the Italian NHS, specifically about the consequences of the interrelation between the normative apparatus of the Italian NHS, performance measurement tools and the results in terms of health and economics of the healthcare facilities on which those performance measurement tools are used. Third, the manuscript aims to suggest the characteristics of a good performance management system suited for healthcare organisations. The thesis provides a study of the Italian NHS since its establishment and analyses its current version, which is still implementing the managerialisation process started with the 1992 and 1993 reforms. Starting from this, the focus is on performance measurement methodologies and theories, which help to elaborate the conclusions.