The relationship between quality management systems and organizational performance in the Italian National Health Service.

This study aims to define the underlying factors of the quality management systems that are the best predictors of public health-care providers' organizational performance and to assess the impact of those underlying factors on performance. To reach the research objectives, a national survey involving all the Italian public health-care providers (352) was carried out. The total response rate was around 42%. The findings confirmed that the quality elements described in literature as "core values" could be considered critical factors of the quality management systems adopted by Italian health-care providers. Unlike similar studies and models currently employed by the quality award organizations, this study considered the variables related to the existence and role of the quality department. The results highlighted that this element was an important underlying factor of the quality management systems adopted by Italian health-care providers. As for the impact of the characteristics of the quality management systems on organizational performance, the results showed that the outcome subjective performance was positively related to quality management variables, but there was a lack of a significant statistical relationship between financial performance and quality management. This seems to be consistent with a health policy that, so far, has not stressed sufficiently the reinforcing effect of simultaneously pursuing quality and efficiency. A health policy that intends to reach both microeconomic efficiency and service quality, on the contrary, should promote and emphasize the synergies between these two objectives. Such a conclusion seems to be an underpinning assumption of the recent National Health Plan (2006-2008) that, finally, mentions the relationship between quality and efficiency as a way to achieve macroeconomic stabilization.