Framing caesarean section reduction policies through a dynamic performance management approach: A maternity pathway case-based analysis

The World Health Organization since the last three decades strongly encourages countries to reduce the caesarean section (CS) rate down to 10–15%. However, this goal nowadays appears still far from its achievement. Public decision-makers are indeed struggling to design and implement effective policies to reduce the CS rate. The literature provides a wide range of factors causing a change in the CS rate, such as the patient clinical profile and the healthcare service quality provided. Maternity pathway (MP) is considered a mean through which to standardize the cares and to reduce CSs. This study investigates the MP recently introduced in Sicilian local health authorities. Based on such an analysis, an outcome-based performance management approach has been used by the authors to build a system dynamics model. Scenario simulation results reveal that such an approach may support decision-makers to learn how to design CS reduction policies. It particularly remarks the necessity to implement policies oriented to coordinate the actions undertaken by the different actors playing a crucial role in the MP.