Operationalizing proper functioning of performance measurement systems in the Italian public healthcare sector

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