When the Rubber Meets the Road: Isomorphism, Rhetoric, and (Mis)management of Interinstitutional Performance

Abstract

In 2012 Performance measurement systems (PMSs) became compulsory in the Italian National Health Service (NHS). The objective of this article is to answer the following research question: How do health-care organizations set up their PMSs in order to make them coherent with the institutional context and the intra-organizational dynamics? The findings show how the similar behavior of the organizations may be considered a case of coercive isomorphism. This study confirmed many topics discussed in the performance measurement literature and opens a discussion of some new research questions.

Keywords:

• performance measurement
• isomorphism
• rhetoric
• health care

Notes

¹ Management accounting can be defined as “a collection of practices such as budgeting or product costing” (Chenhall, 2003, p. 129).

² There are thus three dimensions with two alternatives, the combinations thereof generating eight possible scenarios (Bouckaert, 1993).

³ Called “Piano della Performance.”

⁴ North of Italy; regional capital, Milan; 10 million citizens; covers 23,800 km², roughly the size of New Jersey.

⁵ The CEO is appointed by the region using a spoil system methodology. The CEOs are given annual objectives by the region and they are measured on their achievements (their reappointment is also based on their performance).