Performance Management and Goal Ambiguity: Managerial Implications in a Single Payer System

Background: Goal ambiguity influences the effectiveness of performance management systems to drive organizations toward enhanced results. The literature analyzes the antecedents of goal ambiguity and shows the influence of goal ambiguity on the performance of U.S. federal agencies. However, no study has analyzed goal ambiguity in other countries or in health care systems. Purpose: This study has three aims: to test the validity of a measurement instrument for goal ambiguity, to investigate its main antecedents, and to explore the relationship between goal ambiguity and organizational performance in a large, public, Beveridge-type health care system. Methodology: A nationwide survey of general managers of the Italian national health system was performed. A factor analysis was used to validate the mono-dimensionality of an instrument that measured goal ambiguity. Structural equation modeling was used to test both the antecedents and the influence of goal ambiguity on organizational performance. Results: Data from 135 health care organizations (53% response rate) were available for analysis. The results confirm the mono-dimensionality of the instrument, the existence of two environmental sources of ambiguity (political endorsement and governance commitment), and the negative relationship between goal ambiguity and organizational performance. Practice Implications: Goal ambiguity matters because it may hamper organizational performance. Therefore, performance should be fostered by reducing goal ambiguity (e.g., goal-setting model, funding arrangements, and political support). Mutatis mutandis, our results may apply to public health care systems of other countries or other "public interest" sectors, such as social care and education.