The public sector performance management (PM) literature is particularly rich as this topic is one of the most appealing for public sector scholars (Pollitt, J Public Adm Res Theory 6:25–44, 2005). However, organizational performance (OP) has been neglected across the world (Andrews et al. J Public Adm Res Theory 21:i301–i319, 2011) as well as in the Italian public administration (Martin and Spano, Public Money Manag 35:303–310, 2015). This chapter investigates how OP is defined, measured, and evaluated in the Italian health care sector. Our analysis showed the limited use of performance management in Italian public health organizations and a high variability in the way OP is defined and measured. This makes it difficult to compare the results of different organizations. For this reason, future standardization could allow policy makers to improve the accountability.