Fostering Collaborative Governance in Chronic Disease Management Programs: A Dynamic Performance Management Approach

Chronic diseases are the leading cause of disability and mortality in the world and represent a global health emergency due to the increase in frequency and complexity that has been occurring in recent years. The outcomes related to chronic care needs depend on the joint effort of a multi-provider, multi-disciplinary, and multi-professional service network, which operates along a clinical pathway. However, all the different players involved in the provision of services may have different interests and goals derived from their organizational structure and their role in the overall health system. This context of fragmented governance makes performance management of care services problematic. It requires the assessment of inter-organizational relationships of the multiplicity of providers involved in the service delivery. This chapter aims to show how a dynamic performance-based perspective may effectively support chronic care management and help decision-makers focus on critical drivers impacting on desired results. For this purpose, the chronic disease management program implemented in the Lombardy Region (Italy) was used as a basis for developing a Dynamic Performance Management framework. This approach is then used to address obstacles impeding the success of the chronic disease management program and to outline alternative policies the different decision-makers involved in the healthcare pathway delivery may implement to improve the whole program performance.