Measuring effectively in healthcare: From the governance of the system to the management of the organizations, and back

The adoption of performance measurement frameworks (PMFS) by regulators in public health systems has progressively increased. The aim of this paper is to explore under which conditions PMFs are effective, with a specific focus on the acceptance of these frameworks by individual healthcare organizations. The case study of a major Italian teaching hospital, engaged in a National Programme for Outcomes Assessment, suggests that an effective goal communication strategy, the effect of reputation for excellence, the support of the techno-structure that is trained to address clinical governance issues, and a diffuse evidence-based medicine culture are key elements of a successful implementation.