Includes bibliographical references and index.

My PhD research project focused on the performance quality of the Italian National Health System after the process of humanization, which defines health assistance as patient-centered and patient-empowering from treatment decision making till performance assessment. Humanization aims to increase health services quality as support to patients global (both clinical and psychological) well-being to ultimately enhance the quality of health outcomes for patients (Hellen, 2002). Although quality of care is recognized as the goal of health services performance, techniques for such quality assessment are still in development. Effectively, health organizations need to evaluate performance quality by aggregating unbiased patients and providers opinions (intrinsically highly subjective) on a highly sensitive topic as health. Hence, actors involved in evaluation should preferably be in a long-term relationship; accordingly, I chose to study the hospital department of diabetes. Thus, my research goals were to study patient participation and to evaluate indicators in the performance quality assessment.Evaluation of quality is intrinsically a methodological challenge because it involves actors perceptions of healthcare performance and experience. Nonetheless, it is one of the criteria for a scientific and evidence-based evaluation of healthcare performance. Although such factors are linked to treatment efficacy and outcomes, they are harder to evaluate than factors which lend themselves more readily to quantification. Consequently, I chose an explorative research design, whose techniques and tools are almost all qualitative. Focus groups, in-depth interviews, and non-participant observation, in addition to questionnaires, were employed to collect as objectively as possible data from managers, doctors, and patients.

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