The relevance of indicators and the performance dimension for accountability purposes

The process of corporatization aimed at recovering the functionality of the National Health Service (SSN), the consequent accountability linked to the management of the resources assigned to the articulations that compose it, the recognition of freedom of choice in the access to health services as a condition of competition between providers in order to counteract the implosion of static models incapable of creating value, have made necessary a multidimensional approach to performance measurement, consistent with the new regulatory framework outlined by the health reforms of the 90s. In fact, it is considered a determining lever for accountability, i.e. it is believed that the measurement of results achieved can translate into a process of empowerment of operators to the extent that it is linked to the publication of data and therefore to an informative return of their work with objective, clear and transparent measurements. Measuring performance means setting quantifiable objectives, defining the expected results, associating indicators with the objectives that can adequately measure both the path and the degree of achievement of the same, systematically measuring, at defined intervals, the value of the indicators. The importance of performance measurement/evaluation, and of its techniques, has grown in tandem with the expansion of both internal reporting procedures within individual healthcare providers, and forms of public reporting that are open, or at least accessible, to citizens. With reference to internal recipients, the use of a system of indicators to measure performance is a valid support for the purposes of management control to guide management in decision-making processes; with reference to external recipients, such a system constitutes the means to be able to give them an account of the results of the actions undertaken. Together with the concept of responsibility, the principle of accountability presupposes that of transparency, understood as access to information concerning every aspect of the organization, including management indicators and communication tools aimed at making decisions, activities and results visible. The present work is composed of an introductory part dedicated to briefly illustrate the concept of production, of one referred to outline the importance of a system of indicators as an essential support in decision-making choices aimed at continuous improvement of performance, and of a final part in which it was intended to emphasize the importance of designing a management control system integrated with a quality management system, as a tool for internal management control within the health care company and external reporting of its work, better known by the term "accountability".