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Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare.

L'impact positif de la motivation de service public sur plusieurs résultats individuels dans le travail des employés du secteur public n'est plus à démontrer. Des recherches récentes sur le « côté obscur » de ce trait individuel ont toutefois conduit certains chercheurs à suggérer que les conditions organisationnelles, telles que les contraintes procédurales, pourraient affecter la motivation des personnes, conduisant ainsi à la démission des travailleurs tournés vers les autres. Cette étude explore les relations entre l'une des dimensions de la motivation de service public – à savoir l' abnégation – les contraintes procédurales et l'engagement organisationnel en étendant le modèle Exigences – Ressources de l'épuisement professionnel de l'engagement organisationnel à différents contextes institutionnels. L'étude utilise une approche mixte qui combine des données quantitatives (modélisation par équation structurelle) et qualitatives (groupes de discussion et entretiens approfondis) provenant de trois secteurs en Italie (santé, administration publique locale et organisations sans but lucratif). Nos résultats montrent que l'abnégation modère positivement la relation négative entre les contraintes procédurales et l'engagement organisationnel. Les résultats mettent également en évidence certains des effets indésirables de l'abnégation auxquels les organisations doivent faire face. Remarques à l'intention des praticiens Les employés motivés de façon désintéressée ont tendance à être plus sensibles aux procédures contraignantes et sont donc susceptibles de ressentir plus durement les effets de ces conditions sur leur engagement. Étant donné que le secteur public est un contexte de travail hautement bureaucratique, les sources et les remèdes à ce problème méritent que les chercheurs et les praticiens de l'administration publique s'y intéressent. Les résultats de l'étude confirment l'intérêt de l'élaboration de pratiques visant à éviter aux employés motivés de façon désintéressée de risquer d'entrer dans un cycle de l'échec et de problèmes psychologiques.

The positive impact of public service motivation on several individual work outcomes of public sector employees has been documented. Recent research into the 'dark side' of such an individual trait, however, has led some scholars to suggest that organizational conditions such as procedural constraints could affect one's motivation, thus leading to the resignation of other-oriented employees. This study explores the relationships between one of the dimensions of public service motivation – namely, self-sacrifice – procedural constraints and organizational commitment by expanding the job demands–resources model of organizational commitment to different institutional settings. The study employs a mixed-methods approach that combines quantitative (structural equation modelling) and qualitative (focus groups and in-depth interviews) data from three industries in Italy (health, local public administration and non-profit organizations). Our findings show that self-sacrifice positively moderates the negative relationship between procedural constraints and organizational commitment. The findings also highlight some of the undesirable effects of self-sacrifice that organizations have to deal with. Points for practitioners Selflessly motivated employees tend to be more sensitive to burdensome procedures, and are hence likely to experience tougher effects of such conditions on their commitment. Given the evidence of the public sector being a highly bureaucratic working context, the sources and remedies for this issue deserve attention from both public administration scholars and practitioners. The findings of the study support the development of practices aimed at warding selflessly motivated employees from the risk of entering a loss cycle of psychological impairment.

The Italian Health Care System is a public health system which provides universal coverage for comprehensive and essential health services through general taxation. Since the early 1990s, a strong decentralization policy has taken place in Italy and the State has gradually ceded its jurisdiction to the 20 Italian Regions. These Regions now have the political, administrative, and financial responsibility for the provision of health care to their residents. This shift of power has created some interregional differences in the quality of healthcare services. However, eight Italian Regions have adopted the same Performance Evaluation System (PES) since 2008. It was designed and implemented to monitor about 160 indicators. The Regional Network has offered valuable information and the opportunity to adopt managerial tools that can be used to drive performance improvement and achieve equity. This paper firstly describes the methodology followed by the eight Regions in defining their priorities and setting their targets, relying on the multidimensional data the Inter-Regional Performance Evaluation System provides. It secondly enquires how some Regions have applied and adapted this methodology to their characteristics and strategies.

PurposeThis study aims to systematically review the literature on the use of customer value for the evaluation of inter-organizational performance, with a wide perspective embracing different contexts and settings.Design/methodology/approachSearching within the Scopus and ISI Web of Science databases, a systematic literature review has been conducted analyzing 41 papers published between 1991 and 2020.FindingsCategorization of customer value and inter-organizational performance measures were developed and the main differences among different settings were discussed.Practical implicationsThe results presented in this study may be helpful for practitioners and managers who, in the completion of their activities, have to maintain strong and frequent relationships with other organizations. In fact, practitioners and managers interested in enhancing customer value and measuring inter-organizational performance may find an innovative perspective linking the two dimensions. They could find the categorizations presented in this study as a starting point for developing a performance evaluation framework suitable for evaluating their present business relationships. In fact, the categorizations provide a panorama of how scholars have measured until now inter-organizational performance through customer value, and therefore, they could choose the measures more appropriate for their situation.Originality/valueNo systematic literature review of the use of customer value for assessing inter-organizational performance has previously been undertaken, especially considering different settings.