Managing performance in Healthcare organisations: Tools, strategies and policy implications

This doctoral research is a compilation of three papers that jointly investigate the tools and strategies for managing performance in Italian healthcare organisations. The premises introduce the three challenges of healthcare quality that will be discussed throughout the dissertation: the need of more comprehensive and integrated outcome data, the existence and the persistence of medical practice variation, and the complexity improving healthcare quality at the regional level. Chapter One addresses the dynamics of introducing the systematic collection of Patient Reported Outcome Measures (PROMs) data and offers insights for the successful implementation of such measures. Chapter Two deals with unwarranted variation and waiting times for elective surgery and provides policy makers and managers with tools able to tackle geographical variation and waiting times without necessarily allocating additional resources. Chapter Three investigates the effectiveness of pay-for-performance programs in driving regional healthcare quality improvement and explores alternative strategies that do not rely on financial rewards. Final remarks, limitations and further research opportunities are presented in the Conclusions section.