In the multifaceted world of Italian healthcare, performance measurement has become a topic of growing importance, often met with skepticism by medical professionals. This skepticism is fueled by the perception that Performance Measurement Systems (PMS) are disconnected from the actual tasks of physicians and their professional values. The recent study “Perceived goal importance, knowledge and accessibility of performance information: Testing mediation and moderation effects on medical professionals’ achievement of performance targets”, conducted by Antonella Cifalinò (Centre for Research and Study in Healthcare Management – CERISMAS, Università Cattolica del Sacro Cuore, Milan, Italy), Daniele Mascia (Department of Business and Management, Luiss University, Rome, Italy), Gabriele Morandin (Bologna Business School, Italy) and Emanuele Vendramini (Faculty of Economics and Law, Università Cattolica del Sacro Cuore, Piacenza, Italy), challenges this view by exploring how perceptions of the importance of goals and the accessibility of performance information can actually influence the achievement of individual performance goals among physicians.

The Italian National Healthcare System (I-NHS), on which the study is focused, provides a particularly interesting context for understanding the dynamics of performance measurement systems (PMS) among general practitioners (GPs). The I-NHS is organized according to a multilevel framework: at the national level, the Ministry of Health is responsible for achieving the broader goals of the system. Regions are responsible for service delivery through Local Health Authorities (ASL in Italian), population-based organizations that provide primary care to residents through their facilities. At the local level, each ASL sets its own strategies, priorities and organizational goals on an annual basis.

Italian general practitioners play the role of “gatekeepers” in the I-NHS, determining who receives access to specialist and hospital care, and are also responsible for prescribing medications. Their high degree of autonomy and geographic distribution has generally limited their communication and coordination with colleagues, as well as their organizational identification. A regional reform introduced in 2007 sought to promote collaboration and integration among GPs through the formation of primary care hubs (NCP in Italian). In this general context, the survey was conducted on a sample of general practitioners working for a specific ASL located in one of the best performing regions in the I-NHS. This ASL provides health services to more than 432,000 individuals and has a long tradition of innovative managerial and organizational models in primary care. 

The sample consisted of 128 completed questionnaires, with a response rate of 55.6 percent. Variables such as gender, management background and NCP affiliation were considered as controls. The statistical analysis uses SPSS Process Macro Model 7 to test the hypotheses. The theoretical framework of the study is based on a body of literature that has explored the impact of PMSs on individual cognitive processes such as the – process, learning, and self-monitoring. Previous studies have shown that the effectiveness of PMSs depends largely on how professionals perceive and use performance information. In particular, professionals in the public sector, such as physicians, tend to respond more to professional values than to managerial authority.

The article makes two basic sets of hypotheses:

• Hypothesis 1a (HP1a): the perceived importance of goals by medical professionals is positively correlated with knowledge of their individual performance information.  
• Hypothesis 1b (HP1b): the perceived importance of goals by medical professionals is positively correlated with their knowledge of their colleagues’ performance information. 
• Hypothesis 2a (HP2a): the knowledge of individual performance information mediates the relationship between the perceived goal importance and the achievement of individual performance goals. 
• Hypothesis 2b (HP2b): the knowledge of colleagues’ performance information mediates the relationship between the perceived goal importance and the achievement of individual performance goals.

A third crucial aspect of the study concerns the perceived accessibility of performance information. The existing literature suggests that simply providing this information is not sufficient to improve learning and the decision-making process. Moreover, the perceived accessibility of such information is highly variable among professionals, even within the same organization. Based on these considerations, this study posits additional hypotheses, HP3a and HP3b, which explore how perceptions of the accessibility of performance information may moderate the relationship between the perceived goal importance and knowledge of individual and peer performance information. 

The results of the study are illuminating: they show that the perceived goal importance is positively related to knowledge of individual and peer performance information. This relationship is further moderated by the perceived accessibility of information. In other words, physicians who see goals as important are more likely to seek out and use performance information, especially if this information is easily accessible. 

Furthermore, knowledge of individual performance information completely mediates the relationship between the perceived goal importance and the achievement of individual performance goals. This suggests that the mere availability of performance data is not enough: physicians must also perceive these data as useful and accessible for improving their performance.

These findings have important managerial implications, as they indicate that health-care organizations should focus not only on the provision of performance information, but also on initiatives that improve the perceived goal importance and the accessibility of that information. This could include training on how to interpret and use performance information, as well as improvements in the usability of measurement systems.

Although the study has some limitations, such as its cross-sectional nature and the focus on a single organization, it offers valuable insights into how individual perceptions influence the effectiveness of Performance Management Systems in professional settings. It also contributes to the existing literature in three significant ways: it provides new information on how medical professionals’ perceptions influence their actual performance, explores the mediating role of perceptions related to performance information, and expands the understanding of individual antecedents of performance information use in the public sector.

In conclusion, the research conducted by Antonella Cifalinò, Daniele Mascia, Gabriele Morandin, and Emanuele Vendramini not only enriches our understanding of how personal opinions can impact the effectiveness of performance appraisal mechanisms in professional settings, but also provides valuable insights for healthcare decision makers. Indeed, this work suggests that a more integrated performance management method, one that considers both objective data and individual perceptions, could be the secret to optimizing the efficiency of the health-care system.