Variables of performance governance model development: evidence from the Italian public healthcare

Purpose – The performance governance model, based on the use of performance information to improve governance, is particularly complex, considering the inter-institutional relationships and community involvement that it requires. In order to contribute to the scientific debate on this model, the paper aims to highlight what are the challenges in developing three variables of performance governance (operational performance measurement tools, governance integration and citizen involvement) in the public health context. Design/methodology/approach – Based on the previous literature, we identified three variables that characterize the performance governance model. We then explored them through the case study methodology applied to the Apulia Regional Health System. Findings – The analysis allows us to conclude that the healthcare system under consideration is still far from applying the performance governance model, but it highlights some factors that are preparatory to the same. Moreover, starting from the empirical evidence, some considerations arise regarding managerial and policy making implications for the variables investigated. Originality/value – The paper contributes to a growing body of critical literature on performance governance contextualizing the analysis in a particularly relevant area of the public sector, namely public health. Furthermore, the research also identifies some potential risks of the performance governance model (rigidity in performance measurement tool, organization-objective-responsibility relationship, participatory illusion).