The Italian interregional performance evaluation system.

This contribution describes the Interregional Performance Evaluation System (IRPES) designed by MeS Lab of Sant'Anna School of Advanced Studies (Pisa-Italy), by highlighting its main characteristics and its evolution.Context: Since its creation in 2008, the IRPES has been developed by researchers from different backgrounds, with the involvement of practitioners and managers, so as to offer support to local, regional and national healthcare management. The IRPES is currently adopted by 12 Italian regions, which share a common performance evaluation system to assess the respective regional healthcare systems' performance.Structure: The IRPES is currently composed of about 400 indicators, which monitor different dimensions of the health systems. About half of them are benchmarked against shared standards, to assess the healthcare systems' performance. Indicators are grouped into around thirty composite indicators.Data visualization: MeS Lab designed innovative tools to deliver a clear representation of the performance of health systems, which in turn facilitate policymakers to gain a dynamic understanding of weaknesses and strengths of the systems they manage. In particular, the more traditional representation tools (such as maps or histograms) are accompanied by new visualisation instruments, such as "the dartboard" and "the stave".Covid-19: With the outburst of COVID-19 pandemic emergency, assessing the resilience of healthcare systems has become the new challenge posed to the IRPES. Thus, 63 novel resilience indicators tailored for the pandemic were introduced, starting from the second semester of 2020. Continuous monitoring of the performance of health systems was equally implemented, which has been essential to policymakers during such a difficult time.