(i) To measure effectiveness, we need to establish objectives or targets for performance. Since these cannot be expressed financially, non-financial targets must be used. The effective level of achievement could be measured by comparing actual performance against target.

 (1) Adherence to appointment times

 • Percentage of appointments kept on time

 • Percentage of appointments no more than 10 minutes late

 • Percentage of appointments kept within 30 minutes of schedule

 • Percentage of cancelled appointments

 • Average delay in appointments 

A problem with these measures is that there is an implied assumption that all patients will be at the clinic by their appointed time. In practice, this will not always be the case.

 (2) Patients' ability to contact the clinic and make appointments

 • Percentage of patients who can make an appointment at their first preferred time, or at the first date offered to them

 • Average time from making an appointment to the appointment date

 • Number of complaints about failure to contact the clinic, as a percentage of total patients seen

 • If the telephone answering system provides for queuing of calls, the average waiting for answer times for callers and the percentage of abandoned calls 

(3) Comprehensive monitoring programme 

Measures might be based on the definition of each element or step within a monitoring programme for a patient. It would then be possible to measure the following.

 • Percentage of patients receiving every stage of the programme (and percentage receiving every stage but one, every stage but two, and so on)

 • If each stage has a scheduled date for completion, the average delay for patients in the completion of each stage 

(ii) A single quality of care measure would call for subjective judgements about the following. 

(1) The key objective/objectives for each of the three features of service 

(2) The relative weighting that should be given to each 

The objectives would have to be measured on comparable terms and, since monetary values are inappropriate, an index based on percentage or a points-scoring system of measurement might be used. A target index or points score for achievement could then be set, and actual results compared against the target.