Efficiency, effectiveness and efficacy: towards a framework for high-performance in healthcare commissioning

This article reports on research to identify the key characteristics of highperforming healthcare commissioning organizations of the future. Previous assessments have focused on efficiency and effectiveness, but have paid no attention to the role of efficacy which this research suggests is crucial. In order for healthcare organizations to become high-performing they must be able to re-construct the criteria of performance for the healthcare system deployed by the government and other key stakeholders. Although this study focuses on English healthcare organizations, this article suggests that the importance of efficacy similarly applies in other sectors and other geographical locations given the dominance of notions of performance worldwide.