Assessing the Effectiveness of a Performance Evaluation System in the Public Health Care Sector: Some Novel Evidence from the Tuscany Region Experience

Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare

Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

Anbrasi Edward and colleagues report the results of a balanced scorecard performance system used to examine 29 key performance indicators over a 5-year period in Afghanistan, between 2004 and 2008

Suppression of NDA-Type Alternative Mitochondrial NAD(P)H Dehydrogenases in Arabidopsis thaliana Modifies Growth and Metabolism, but not High Light Stimulation of Mitochondrial Electron Transport

The plant respiratory chain contains several pathways which bypass the energy-conserving electron transport complexes I, III, and IV. These energy-bypasses, including type II NAD(P)H dehydrogenases and the alternative oxidase (AOX), may have a role in redox-stabilisation and regulation, but current evidence is inconclusive. Using RNA interference, we generated Arabidopsis thaliana plants simultaneously suppressing the type II NAD(P)H dehydrogenase genes NDA1 and NDA2. Leaf mitochondria contained substantially reduced levels of both proteins. In sterile culture in the light, the transgenic lines displayed a slow growth phenotype, which was more severe when the complex I inhibitor rotenone was present. Slower growth was also observed in soil. In rosette leaves, a higher NAD(P)H/NAD(P)(+)-ratio and elevated levels of lactate relative to sugars and citric acid cycle metabolites were observed. However, photosynthetic performance was unaffected and microarray analyses indicated few transcriptional changes. A high light treatment increased AOX1a mRNA levels, in vivo AOX and cytochrome oxidase activities, and levels of citric acid cycle intermediates and hexoses in all genotypes. However, NDA-suppressing plants deviated from the wild type merely by having higher levels of several amino acids. These results suggest that NDA-suppression restricts citric acid cycle reactions, inducing a shift towards increased levels of fermentation products, but do not support a direct association between photosynthesis and NDA proteins

How do microtubules affect deposition of cell wall polysaccharides in the pollen tube?

Callose is the primary polysaccharide present in the so-called secondary layer of the pollen tube cell wall while the content of cellulose in such layer is usually lower. Despite its lower quantity, cellulose might be potentially able to establish the growth direction of pollen tubes. Microtubules have been shown to regulate the deposition of callose synthase in the distal regions of pollen tubes related to the synthesis of callose plugs. However, the interplay between microtubules and cellulose synthase in the pollen tube is unclear. Here, the hypothetical role of microtubules and microtubule-based motor proteins in controlling the insertion of cellulose synthase in relation with growth and directionality of pollen tubes is discussed

Designing the Function of Health Technology Assessment as a Support for Hospital Management

Investment in Health Technologies (HTs) is one of the crucial points for hospital managers. It affects the goals and strategic orientation of the whole Health Organization. Decision-making regarding the employment of new technologies involves, prevalently, the hospital level, which directly concerns the healthcare delivery process and its design. Hospital-Based Health Technology Assessment (HB-HTA) is aimed at selecting the portfolio of new HTs that provides the best balance between competing targets, namely, cost containment and quality improvement. This objective is achievable by thinking about how to improve the service delivered, through the use of innovative cost-effective HT. Accordingly, the HTA role deals with the operational modalities of hospital departments, and it is strictly related to outcomes desired and in respect to budgets. This evaluative process should be coherent with specific health organization necessities given that each one is concerned with its own geographic area, its own specific patients’ epidemiology, the social environment, and financial resources’ availability. However, HTA is usually run by practitioners whose competences contemplate mainly clinical and technical aspects; hence, the absence of a focus on performance management (PM) represents the main weakness of this function. Thus, starting from the current body of literature in the fields of PM and HT management, this work theoretically identifies how to design an HB-HTA func- tion and which the main relevant evaluation perspectives are. By explaining the implementation stages, it will be shown how HTA at the hospital level should be able to combine the different perspectives of business performance (financial and nonfinancial) with clinical needs