Performance measurement in response to the Tallinn Charter: Experiences from the decentralized Italian framework

Background: The Italian National Health Plan 2011-2013 expressly recognizes the Tallinn Charter as the most solid international reference for the definition of National priorities. At sub-national level, many regions apply performance monitoring as an integral part of quality improvement policies. Methods: A national workshop allowed reviewing the state of the art of performance monitoring in Italian regions and Autonomous Provinces in relation to the Tallinn Charter. Participants included representatives of regions and Autonomous Provinces, the National Agency of Regional Health Services, the Italian Ministry of Health and WHO Europe. Six specific questions were used to facilitate brainstorming and to collect updated information. Results: A total of eighteen regions out of twenty-one participated in the meeting. Ten regions were found to use different systems for performance evaluation: two adopting a unique balanced scorecard, two applying different systems for different levels of governance, six using a structured multidimensional system. Different organizational and operational capacities affect the ability to uptake information for policy making. Conclusions: Italian regions are striving to respond to the collective need of performance improvement, through an increased production of systems of indicators and achievement reports that still need to be made comparable across the country. The Tallinn Charter may provide a common platform to improve and share best practices in performance monitoring. The experience of Italian regions is relevant for the international debate and provides specific responses to general questions that can be usefully applied in other decentralized contexts. (C) 2012 Elsevier Ireland Ltd. All rights reserved.