Introduction; References; The Design of Outcome-Based Performance Management Systems in the Public Sector; 1 Shifting from Output to Outcome Measurement in Public Administration-Arguments Revisited; Abstract; 1.1 Introduction; 1.2 Value for Money-Output Versus Outcome Measurement; 1.2.1 Outputs Versus Outcomes: The Conceptualization, Measurement, and Interpretation; 1.2.1.1 Technical Aspects of Measurement; 1.2.1.2 Interpretation Problems in Outcome Results; 1.2.1.3 Output as a Reflection of an Outcome; 1.2.2 How Outputs and Outcomes Connect to Budgeting and Performance Management

1.2.3 The Information Need1.3 Controlling Legitimacy-Output Versus Outcome Measurement; 1.3.1 Controllability of Results; 1.3.2 Controllability of Information; 1.4 Conclusions and Implications; References; 2 Organizational Performance in the Italian Health care Sector; Abstract; 2.1 Introduction; 2.2 Literature Review; 2.3 The Italian Health care System; 2.4 Methodology; 2.5 Results; 2.6 Discussion; 2.7 Conclusions; Annex 1; References; 3 The Iron Law of Unintended Effects, Again? Outcome Measures and Blame-Avoidance; Abstract; 3.1 Introduction and Research Question

3.2 Theoretical Background3.2.1 Public Management Paradoxes: Picking a Theoretical Lens; 3.2.2 Unintended Effects of Performance Management: Some Notable Theoretical and Empirical Contributions; 3.2.3 Under-Explored Facets: Rankings and Blame-Avoidance; 3.3 Methodology and Analytical Framework; 3.3.1 Overall Research Strategy; 3.3.2 In Search of Mechanisms: Analytical Framework; 3.4 Exploratory Case Study; 3.4.1 Context and Background; 3.4.2 A Partial Reform: Moving to a Performance Ranking; 3.4.3 Unintended Effects: Blame-Avoidance Strategies

3.5 Analysis and Conclusions: Conceptualizing MechanismsAppendix: Major Methodological Choices; References; 4 Designing Outcome-Based Performance Management Systems to Assess Policies Impacting on Caesarean Section Rate: An Analysis of the Sicilian Maternity Pathway; Abstract; 4.1 Introduction; 4.2 What Drivers Affect Caesarean Rate?; 4.3 An Analysis of the Maternity Pathway in the Sicilian Region; 4.4 A Dynamic Performance Management Approach to Design a Set of Outcome Measures Impacting on CS

4.5 Applying the DPM Approach to Design a Set of Outcome Measures to Assess Policies Impacting on CS in the Sicilian Context4.5.1 Implications Arising from the DPM Implementation in Assessing CS Reduction Policies; 4.6 Conclusions; References; Towards Outcome-Based Performance Management: Experiences and Trends from Different Countries; 5 The Scottish Government's System of Outcome-Based Performance Management: A Case Study of the National Performance Framework and Scotland Performs; Abstract; 5.1 Introduction; 5.2 The Development of Outcome-Based Public Management