Current performance measurement systems (PMSs) are mainly designed to measure performance at the organizational level. They tend not to assess the value created by the collaboration of multiple organizations and by the involvement of users in the value creation process, such as in healthcare. The purpose of this paper is to investigate the development of PMSs that can assess the population-based value creation process across multiple healthcare organizations while adopting a patient-based perspective. The paper analyzes the development of a new healthcare PMS according to a constructive approach through the development of a longitudinal case study. The focus is on the re-framing process of the PMS put in place by a large group of Italian regional health systems that have adopted a collaborative assessment framework. Framing information according to the population served and the patients’ perspective supports PMSs in assessing the value creation process by evaluating the contribution given by the multiple organizations involved. Therefore, it helps prevent each service provider from working in isolation, and avoids dysfunctional behaviors. Re-framing PMSs contributes to re-focusing stakeholders’ perspective toward value creation; legitimizes organizational units specifically aimed at managing transversal communication, cooperation and coordination; supports the alignment of professionals’ and organizations’ goals and behaviors; and fosters shared accountability among providers. The paper contributes to the scientific debate on PMSs by investigating a case that focuses on value creation by adopting a patient-centered perspective. Although this case comes from the healthcare sector, the underlying user-centered approach may be generalized to assess other environments, processes, or contexts in which value creation stems from the collaboration of multiple providers (integrated co-production).

Health systems face challenges which are inherent to care demand and supply evolution (i.e., demographic change, new technologies) or are the results of unexpected occurrence originating outside the health system, such as economic shocks or epidemic outbreaks. Both challenges often require a paradigm shift in governance and organization, financing and resource allocation, accountability frameworks, as well as public health system responses. Based on key reviews and seminal papers of performance management, public health, sustainability and resilience, the article presents three emerging challenges for performance management systems in healthcare: i) the inclusion of the population approach; ii) the measurement and consideration of the multi-facets concepts of value; iii) the importance of resilience and sustainability. Performance management systems need to evolve to cope with this changing scenario. The article sheds light on uncovered areas by performance management, and it proposes a research agenda for scholars of both performance management and health service research.

Purpose: Lean Thinking is an operation management discipline which aims to identify, map and analyse the activities forming a process to detect “value waste” and outline the most effective flow of activities to execute in sequence. Process mapping is often developed in lean projects through the use of the Value Stream Map (VSM). Like many other management tools, the VSM adopts a static and non-systemic perspective in the representation of an organizational process. This may result in the implementation of Lean projects inconsistent with the overall organizational long-term strategy, thus leading to dysfunctional performance. In order to overcome this limit, the paper suggests combining VSM with System Dynamics (SD) modelling.Design/methodology/approach: The paper is based on a review of the literature on VSM. This review is matched with an analysis of SD modelling principles aimed at explaining the practical and theoretical contribution of this approach to operation and strategic management practices. An illustrative case study is then provided to explore the practical implications of the proposed approach.Findings: Our results show that SD modelling provides robust methodological support to VSM and Lean Thinking due to its inner characteristics, namely: simulation, systemic view, explicit link between system structure and behaviour and effective visual representation.Originality/value: This research proposes a novel approach to design VSMs aimed at fostering a strategic perspective in Lean Thinking applications. Such an approach connects two fields of research and practice – i.e. VSM and SD modelling – which have traditionally been kept separated or, at least, partially combined for specific organizational sub-systems, thereby neglecting a broader strategic view of the entire process system.

Despite the progress made by scholars, empirically investigating entrepreneurial ecosystems (EEs) remains problematic because of the inherent complexities and nonlinearities of interactions among EE actors. The research to date has shown a tendency to focus on macrolevel ecosystem dynamics while neglecting the microfoundations of EEs. We contend that this negligence is due to a lack of appropriate methodologies that can capture EE microfoundations through a systemic value-based perspective. To fill this gap, in this article, we propose a novel methodological approach, the value system method, which enables framing EEs through critical causal interdependences between key actors’ business models that foster value-exchange processes. Finally, the study provides a set of research and policy implications for fostering the understanding of EE microfoundations toward a value-based method and theory.