Purpose – In recent years, health care organizations have adopted multidimensional systems for evaluating the health services performance. Alongside the clinical and economic indicators are inserted customer satisfaction to provide a perspective of analysis to the stakeholders of the system. The health management is therefore, by having to draw new organizational strategies to overcome information asymmetry that hangs over these organizations. The purpose of this article is to provide an overview and assessment of the systems performance measurement and present a framework for the identification of a model of performance measurement for adequate health care processes. In healthcare, performance measurement methods emphasize on consideration of multiple factors. The diverse uses of health system performance measures necessitate a wide variety of measurement methods, indicators, analytical techniques and approaches to presentation. Design/methodology/approach – The starting point is represented by the analysis of the Spanish health system, which in this phase of general rationalization has maintained levels of efficiency and positive efficacy. This study uses case study method and develops a conceptual framework for performance measurement and implementing improvement projects. The proposed model has the following six steps: 1. Identify factors to measure performance. 2. Identify organizations system that can provide a comparative analysis. 3. Analyse service performance using Spanish National Health System 4. Plan, implement and evaluate improvement measures. Practical implications – The Spanish National Health System (SNS) is characterized to ensure universal coverage, to be financed through taxes and to have a decentralized health services management in all the Comunidades Autónomas (Autonomous Communities, ACs). The main goal of the SNS is to ensure equality in health care to its citizens independently of where they reside, as well as ensuring a high quality of services provided. Therefore, with the Key Performance Indicators for the Spanish National Health System (INCLA-SNS), we can analyse in which way the SNS achieves this purpose. So, 13 performance indicators were selected for this study from the 50 essential indicators. Originality/value – The framework presented provides a performance measurement system for healthcare processes that is sensitive to change in the external and internal environment of an organization. The identification of these indicators is finalized to implement future research that is to verify the possibility of achieving a model of performance indicators translatable to other health systems in the first place to Italian.