Given the growing attention to changes in performance measurement and evaluation systems in healthcare contexts, the present study aims at improving our understanding of such processes within teaching hospitals, examining how managerial and health-professional logics contribute to these changes. In the theoretical part of the study we analyse teaching hospitals as multistakeholder contexts. Particularly, we propose a theoretical approach that represents changes as dialectical phenomena so as to explain how the interaction among influential stakeholders (representing managerial and professional logics) affects changes in performance measurement and evaluation systems. The empirical part of the paper is devoted to a case-study focused on changes in performance measurement and evaluation systems in a Sicilian teaching hospital. The empirical analysis aims at examining the observed changes in the light of the theoretical framework proposed, emphasizing the interactions among the logics that characterize the teaching hospital context.
