Integrated planning in healthcare: Evidence from PIAO indicators

Purpose: The study examines how integrated planning is implemented in healthcare organisations through the indicators reported in the Integrated Activity and Organisation Plan (PIAO), assessing whether the framework supports strategic coherence, performance management, and public value creation. Design/methodology/approach: The analysis covers 4,247 indicators drawn from fifty-two PIAO documents issued by thirteen public healthcare organisations in the ATS Milano district, including nine ASSTs, three IRCCSs and the ATS Milano health authority. Indicators were extracted, classified, and analysed across four planning cycles (2022–2024, 2023–2025, 2024–2026, 2025–2027) by type, distribution, and alignment with PIAO sections. Quantitative patterns were integrated with a qualitative assessment of coherence between objectives, measurement logic, and document structure. Findings: Results show high variability in the number and type of indicators across organisations and cycles. Measurement is dominated by volume and process indicators, while outcome indicators are almost absent. Alignment between strategic objectives, performance objectives and human capital planning is limited. Document length grows substantially across the first cycles and remains high in 2025–2027, as annexes are progressively absorbed into the main text, reinforcing fragmentation and weakening the PIAO’s role as a tool for steering and accountability. Research limitations/implications: The analysis focuses on a single territorial area and on what organisations formally report in PIAO documents. Further comparative and process-based studies are needed to assess how the PIAO is used in practice. Practical implications: The findings highlight the need for clearer design principles, more selective indicator sets and stronger connections between strategic objectives, performance measurement, and human capital planning to support public value. Originality/value: This is the first empirical study to systematically analyse PIAO indicators in healthcare. It documents how integrated planning is interpreted in practice, explains why current implementations remain largely activity based and clarifies the conditions required for the PIAO to function as a genuine integrated planning and public value framework.