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The performance evaluation system for regional health systems

The Management and HealthCare Laboratory (MeS) of the Institute of Management developed a multidimensional system for evaluating the performance of healthcare services. The indicators contributed to a process of improvement in the health services
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In 2004, the Management and Health Laboratory (MeS) at the Institute of Management developed a multidimensional system for evaluating the performance of health services in Tuscany Region then also introduced in other Italian Regions. This system obtained two patents owned by the Tuscany Region and the Scuola Superiore Sant'Anna. The performance indicators have been selected thanks to a continuous process of comparison and sharing with health professionals, officials and policymakers of the Region that accepted to test the Performance Evaluation Network, and consequently adopted the performance evaluation system designed by the MeS Laboratory.
Among the key success factures of the system, the graphic representation both at indicator level and at the local and regional level through the dartboard diagram. These indicators cover a variety of evaluation dimensions, such as population health status, efficiency and sustainability, communication and processes, regional health strategies, internal evaluation (of employees), external evaluation (of users), clinical care evaluation. The indicators are benchmarked using 5 assessment bands with associated colours that intuitively communicate whether the situation is positive or negative. The assessment bands can be summarised as follows: 1) very poor, which is associated with a red colour, 2) poor, with orange colour, 3) average, with yellow colour, 4) good, with green colour and 5) excellent, with dark green colour.
The PREMs and PROMs Observatories were established in 2018, as a result of the MeS Laboratory's long-lived experience with surveys and are aimed at continuously collecting and providing managers and healthcare professionals, at every level of the healthcare system, with feedback from patients in order to support them in their activities and enhance improvements in care practices and service processes.

Development of the innovative solution

The evaluation system is used to introduce new topics, new way of collecting information and getting them back. One of the most significant recent innovations relies upon the new graphic visualization of the results of the healthcare pathways through the display of "pentagrams". This representation integrates the target diagram. They reproduce the performance of healthcare pathways by tracing the stages of patients along the path. This new representation proposes a paradigm change in visualizing tool: from organization to patients. These systems are already in use in various national and international settings.

Social, economic and environmental impact and benefit 

Patients' experience of services and patient-reported outcomes are increasingly recognised as a key measure of the quality of health services provided, alongside other measures involving clinical, effectiveness, service efficiency, and patient safety. Patient-reported data are critical for defining and implementing actions to improve the quality of health services from a patient-oriented perspective.
The evaluation system has had a significant and positive impact on the planning and regulatory activities of regional health care systems. About half of the Italian regions use the target. The evaluation system is currently used to support planning and programming processes at local and regional level and it is linked to the rewarding systems of the regional health care systems. In addition, the orientation towards the public disclosure of results has helped to strengthen the link between citizenship and public administration, leveraging the accountability and transparency of the system.
The regions participating in the network have, on the one hand, recorded a tendency towards improved quality levels of the health services offered which tends to be more significant than in the other regions with a percentage of improved indicators exceeding 60%, in 2018, and on the other hand, they have reduced the intra-regional variability in quality levels thus contributing to increasing the value for health care system.
The adoption of the evaluation system has  contributed to increase the value produced by the health providers by decreasing the geographic variation of services thus ensuring more equity.