Ideal-Types of Performance Management Approaches: An Analysis of Italian Local Health Units

Bouckaert and Halligan (2008) proposed four ideal-types of performance management systems; from a disconnected and input-led approach (performance administration), to a model in which the integration of performance management is fully integrated with both the internal and external context of the organization (performance governance). These ideal-types exerted a strong influence on the subsequent literature on public performance management; yet, their application has been only episodically investigated in the healthcare sector (Halligan et al., 2012; Tenbensel e Burau, 2017). This article empirically analyzes performance plans issued in 2020 by Italian local health units with the aim to investigate the following research question: after over a decade since the adoption of the main performance framework reform, which dates back to 2009, which is the main ideal-type adopted by local health units in Italy? In order to pursue this research objective, a model for a qualitative evaluation of the contents of performance plans has been defined, featuring six dimensions of analysis able to capture both the features of the ideal-types and what is prescribed by performance law in Italy. Our final sample consists of 63 performance plans out of 99 total Italian Local Health Units. Our findings suggest that it is difficult to identify specific territorial clusters. The Italian healthcare context seems significantly heterogeneous. From an overall perspective, the prevailing ideal-type is that of "management of performances". By looking at each of the 2 specific interest’s areas, we found that the prevailing weakness is related to the definition of indicators. At the same time, Local Health Units are more familiar with stakeholders’ and context's analysis. Two elements considered as relevant for a "performance governance"- oriented approach. An interesting further development of the research could be related to a focus on a subset of Regions with similar trends, integrating the analysis of documental sources with primary and qualitative data that can be acquired through key players' active involvement (surveys or interviews).