Digital Theses Archive


Tesi etd-10122020-223040

Type of thesis
Continuous and systematic benchmarking as a practice to improve healthcare performance: commentaries on the development and implementation of approaches in diverse scenarios
Scientific disciplinary sector
relatore Prof.ssa NUTI, SABINA
Membro Prof.ssa BOSA, IRIS
Membro Dott. BELLE', NICOLA
  • Benchmarking
  • Best practices
  • Evidence‐based management
  • Health system
  • Maternity pathway
  • Paediatric care
  • Patient reported experience measures
  • Performance assessment
  • Performance management
  • Performance measurement
  • Small countries
Exam session start date
This Ph.D. dissertation is intended to consolidate and concretize the messages found in the literature, that continuous and systematic benchmarking can be an effective management practice to improve health system performance. It also seeks to enrich the body of literature regarding the design, development and implementation of evaluation tools based on systematic benchmarking of data across diverse institutions at different levels in the health system.<br><br>The introduction provides a brief excursus of the origins and uses of benchmarking in the management field. Particularly, this section describes the main roles of benchmarking in management practice, how it originated in the private sector for support functions as an alternative to market mechanisms, and that it can work successfully also in the public sector in order to overcome autoreferential behaviors in public organizations. Secondly, focusing on the health sector, it shows that there can be difficulties and challenges in applying benchmarking, but that these can be overcome by utilising the characterising elements of the health system itself. This conclusion, that benchmarking can be applied successfully also in the public health sector, is further enforced by the assumption that it may leverage the principles of social comparison theory and reputational mechanisms.<br><br>Following the introduction, this dissertation includes three chapters. The first chapter reports the experience of the design, development and implementation of a health system performance assessment framework for Latvia. Through this case study, it describes how administrative data can be used effectively to compare diverse actors in the international scenario. The second chapter explains how innovation and technology can be helpfully included in such processes of collecting and benchmarking results, in particular when considering data provided externally by users of health services. The third chapter illustrates how such data in benchmarking can become not only a source for evaluation systems, but also a stimulus and an inspiration to embark on improvement actions.<br><br>From the literature, it emerges that benchmarking is more widely diffused in theory than practice. This dissertation seeks to contribute to such an exhaustive theoretical background by providing ongoing experiences aimed at putting theory into practice on a broader scale, starting from examples of local success based on a series of characteristic features of the performance evaluation systems (such as political commitment, accountability and voluntary adhesion).