Thesis title: Performance in Public Administration: theoretical models, application tools and case studies from research and healthcare institutions
In recent decades, the issue of performance has taken on an increasingly central role in the modernisation of public administration, becoming a strategic lever for guiding public action towards effectiveness, efficiency, and transparency. This doctoral thesis systematically addresses performance measurement and management in complex public administrations, with a specific focus on public research institutions and the healthcare sector.
After a theoretical reconstruction of the evolution of organisational models and reform paradigms – from bureaucratic logic to New Public Management – the thesis explores the concept of performance in its various dimensions, analysing the regulatory and methodological tools introduced in the Italian context.
Building on this conceptual framework, the thesis focuses on a case study of the Istituto Superiore di Sanità (ISS), conducting an in-depth analysis of the strategic planning and performance evaluation systems adopted by the institution. The analysis combines a review of the main planning tools in their regulatory and practical evolution with a qualitative and quantitative investigation that includes a systematic literature review (following the PRISMA protocol) and a bibliometric analysis aimed at mapping the most widely used performance measurement models in the public sector, with particular emphasis on research institutions. Based on the evidence collected, a customised Balanced Scorecard (BSC) is developed, structured around the model’s four key perspectives (financial, internal processes, learning and growth, stakeholders), and applied to the ISS over the 2021–2023 period. This application enables an assessment of the alignment between the institutional mission – centred on promoting public health through research, surveillance, training, and technical-scientific advice – and the objectives actually pursued.
The Balanced Scorecard has proven to be not only a useful tool for performance measurement, but also a strategic lever for informing future organisational decisions. It enabled the translation of analytical findings into concrete improvement actions, including process optimisation, more efficient resource use, and the alignment of objectives with the institutional mission. Thanks to its multidimensional structure, the BSC facilitated an integrated view of the organisation’s various functions, reinforcing the connection between strategic planning, operational activities, and the impact on public health and community value.
In addition to the strategic dimension, the thesis also addresses operational performance through a case study conducted at the Policlinico Umberto I hospital in Rome. In this setting, a multi-objective optimisation model was applied to the weekly scheduling of operating theatres, taking into account real organisational constraints, clinical priorities, and equity of access. The case illustrates how integrating performance management tools with advanced quantitative methods can improve operational efficiency, equity in service delivery, and decision-making quality in highly complex hospital environments.
The thesis proposes an integrated view of performance, in which strategic and operational dimensions are conceived as interdependent components of a unified governance cycle that spans all phases of public action: from goal-setting to daily operations, and from results measurement to evaluation and reporting. In this perspective, performance becomes a core element for ensuring consistency, transparency, and adaptability in public organisations, contributing concretely to the generation of public value.
In conclusion, the thesis offers an original contribution to the debate on public sector performance, combining theoretical rigour with empirical validation. It presents conceptual frameworks and operational applications based on advanced tools – such as the Balanced Scorecard and multi-criteria optimisation – applied to real-world cases (ISS and Policlinico Umberto I) to demonstrate how performance management can serve as a critical tool for guiding decisions, optimising processes, and ultimately creating public value.