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Changes in the management control system of the Italian National Health Service have occurred in the past 20 years, to align with New Public Management (NPM) principles. Healthcare organizations have begun to implement performance management systems (PMSs) as well as new tools, such as the balanced scorecard (BSC). To understand how performance information could be integrated into management decisions, we analyze the newly implemented PMS in the Verona Integrated University Hospital (VIUH). This organization was created by merging a teaching hospital and the independent hospital of Verona. To understand the goals of VIUH’s PMS and the factors enabling or hindering its adoption, we conduct a qualitative analysis on several semi-structured interviews. The study reveals that the introduction and implementation of the PMS in VIUH was mainly a result of the hierarchical control of the regional government and, in striving to uphold professional quality indicators, as a response to clinicians’ resistance to change.