Risk management and performance measurement: excellent experiences in italian health care institutions.

The risk must not be lived as economic but structural phenomenon, not as element of trouble but as characterizing element of the company activities that, if correctly managed, it permeates the value creation processes. In this context a global afterthought of the strategies is needed, the business performance processes, that pressures to reduce costs, to improve quality, to maximize effectiveness, efficiency and empowerment, have to be reprogrammed in order to give them a patient centralization. Although many contributions have been proposed analyzing performance management, less attention has been focused on interrelation with the risk management. Particularly, the empirical validation of the risk evaluation is represented in the international literature, especially regarding the health care system , but these studies are less represented in the Italian contributions. This work tries to explore the existence of the relation between risk management and performance measurement in Italian health care systems, regarding managerial processes in order to give them a customer/patient satisfaction orientation. The final target is to build a theoretical framework in order to represent this kind of relationship in a logic of patient centralization. For this, we need to use the Enterprise Risk Management (ERM) model produced in 2004 by the Committee of Sponsoring Organizations of the Trade-way Commission (CoSO). ERM is not strictly a serial process, where one component affects only the next. It is a multidirectional and iterative process in which almost any component can influence another. There is a direct relationship between objectives, which are what an entity strives to achieve, and ERM components, which represent what is needed to achieve them. Empirical way has been realized by analyzing two Italian excellence realities (Clinical Institute Humanitas and Children’s Hospital Bambin Gesù), crossing the database of the private IRCCSs (in total 42) and that one of the Italian companies JCI certificated (in total 9). The key reading of the empirical analysis is understandable making a parallelism among the two entrepreneurial realities: absolutely different health care firms for history, institutional order, territorial position, physical-structural connotation, performances measurement management, medical specialization and managerial configuration, are united only by the risk management approach and by the vocation of the business management to processes logics. In such way, it finds justification and confirmation how much affirmed in literature that they cannot exist a general politics of the firm and a risk management politics thought in separated ways. Defined the existence of the direct relationships between the risk management and the managerial approaches of the health care enterprises, here we build an up-graded framework, that tries to explain as the risk business approach cannot be understood only as an operative step or tool, but like a “holistic” paradigm, in degree to permeate all managerial performances and processes.