Integrating Mandated Planning: Action Research in a Public Hospital

Abstract

Purpose: This paper investigates how an interventionist action research process can transform a normatively mandated planning instrument PIAO from a siloed compliance document into a cross-organizational performance management system oriented toward community accountability.

Design/methodology/approach: An interventionist action research study was conducted at a northern Italian research hospital over eight months (May 2023–January 2024). Twenty-nine participants across clinical, administrative, research, and managerial functions engaged in three structured phases. Two researchers maintained differentiated roles, process conductor and analytical observer, producing independent reflective notes analysed through a framework analysis approach.

Findings: Three enabling mechanisms are identified through which the transformation was achieved: shared value anchoring, interdependence visibility, and progressive accountability. In this intervention, these mechanisms unfolded in a consistent sequence: each appeared to produce the organizational conditions that supported the next. The intervention extended the organization's pre-existing Balanced Scorecard infrastructure toward the public value dimensions required by the PIAO, achieving indicator consolidation, relational document architecture, and Gender Equality Plan integration.

Research limitations/implications: The single-case design, justified on theoretical sampling grounds, limits direct generalization to organizations with different measurement infrastructures or governance cultures. The absence of longitudinal data leaves the sustainability of the integration achieved as an open empirical question. Future research should test the enabling mechanisms in contexts without pre-existing planning infrastructure and follow organizations through multiple PIAO cycles.

Practical implications: Regulatory compliance alone cannot produce an integrated PIAO. Facilitated organizational processes activating the three mechanisms in sequence appear, in this case, to be conditions for substantive integration.

Originality/value: The paper's primary contribution is a mechanism-based account of how a mandated planning architecture can be transformed into a functioning, integrated performance management system in an organization with mature measurement infrastructure. This account extends the Ferreira and Otley framework to normatively mandated performance management system design and yields a replicable action research design for the redesign in mature measurement environments.