Performance evaluation in healthcare: a narrative review of recent advances and challenges in Italy
Background and Objective: Performance evaluation in healthcare is essential to enhance service quality, resilience, and cost-effectiveness. In Italy, despite regulatory reforms such as Legislative Decree 150/2009 and tools like the Interregional Performance Evaluation System (IRPES), many healthcare organizations still struggle to implement integrated performance governance models. This narrative review aims to explore recent advancements in healthcare performance evaluation in Italy, compare them with selected European experiences, and identify key challenges and improvement opportunities. Methods: A systematic search was conducted in PubMed, Scopus, and Google Scholar, focusing on literature published from 2014 to 2024, with emphasis on the past 5 years. Eligible articles were empirical studies or systematic reviews, written in English or Italian, addressing performance evaluation of healthcare professionals in Italy and selected European contexts. Studies unrelated to healthcare or published outside the specified timeframe were excluded. Data extraction was conducted qualitatively by thematic synthesis. Key Content and Findings: Out of more than 100 records screened, 30 articles met the inclusion criteria. The findings highlight persistent gaps in the adoption of governance-oriented evaluation models, with Italian Local Health Authorities (ASLs) often relying on administrative rather than strategic performance tools. While IRPES provides extensive benchmarking indicators, integration of long-term outcomes and public value frameworks remains limited. Innovative practices such as 360-degree feedback, competency-based evaluation, and the role of “professional managers” are emerging but unevenly implemented. Comparative insights from European countries underline the relevance of contextual flexibility and decentralised policy design. Conclusions: To modernize healthcare systems, performance management must strike a balance between quality, efficiency, and equity. Investments in training, technological tools, and collaborative governance are vital. Embracing public value principles and outcome-based evaluation can enhance transparency, staff engagement, and health service resilience. Future policies should address regional disparities, standardize evaluation practices, and support cultural change toward merit-based, participatory models.
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