The New Public Management (NPM) reform fostered the adoption of performance management systems (PMS) in the public healthcare sector. This is characterized by multiple governance levels and providers which work with the aim to create public value for a reference community. In order to take this institutional fragmentation into account, PMSs were designed and implemented at different institutional levels – i.e. micro (organization) and macro (region, country). This research aims at exploring the role played by micro and macro PMSs and their combination in the public healthcare sector. Particularly, this study focuses on the perception of heads of the departments – who are healthcare professionals with managerial responsibilities with regards to their clinical units – and concerns management competencies and information sharing, which are considered predictors of organizational performance. The analyses were conducted using the 2014 survey on organizational climate of Tuscany (Italy). This represents an ideal case study since this region from 2005, in addition to the micro PMSs systems mandatory by law, has also adopted a macro multidimensional PMS based on benchmarking and public disclosure of performance results. Findings show that the combination of both micro and macro PMSs largely enhances the perception that HoDs have on management and information sharing. These results may support the idea that the combining micro and macro PMSs in public healthcare sector may foster organizational performance.