Tackling wicked problems in performance management and governance of public health: an empirical analysis of COVID-19 vaccination strategies

Abstract

Purpose: Public health strategies and activities are intrinsically complex. According to the literature, this “wickedness” depends on the different interests and expectations of the stakeholders and the community, the fragmented governance of the related services and the challenges in measuring and assessing public health outcomes. Existent performance measures and management systems for public health are not designed to cope with wickedness since they are mainly focused on inputs and outputs, neglecting broader outcomes because of their long-term impact and the poor accountability of results. This research aims to tackle this shortfall by adopting a dynamic performance management (DPM) approach. Design/methodology/approach: This research explores the case of the vaccination campaign of a Regional Health System. Through the analysis of an illustrative case study, the research discusses both opportunities and limits of the proposed approach. Findings: This research highlights that DPM supports performance management (PM) in wicked contexts, thanks to the adoption of a system-wide perspective and the possibility of using simulation to experiment with alternative strategies and benchmarking performance results with simulated trends. Originality/value: This article tackles a gap related to the management of wicked problems both from a theory and a practical perspective. In particular, this research suggests the adoption of DPM as an approach that may support policymakers in tackling social pluralism, institutional complexity and scientific uncertainty all at once.