Identify appropriate value for money performance indicators for a hospital. The purpose is to highlight some of the difficulties in assessing value for money performance and in particular the conflicts that often arise between the objectives of economy, efficiency, effectiveness and equity.

In measuring performance in the public sector, it is important to consider the resource inputs, the services provided (intermediate outputs) and the impact of these services (final outcomes). Consider, for example, the cancer unit of a hospital that provides services such as chemotherapy to patients. The main inputs, outputs and outcomes are shown in the table below.

Table The four Es

Resource inputs	Services provided (= outputs)	Impact (= outcomes)
Beds, staff, drugs,	Chemotherapy sessions,	Normal lifestyle,
laboratory services,	malignancy removed,	quality of life,
clinical equipment, etc.	post-survival treatment	readmissions, death

(Adapted from Coates et al., 1996, p. 221)

In the context of the cancer unit:

• Economy is concerned with procuring beds, staff, drugs, laboratory services, and so on at the minimum cost for an acceptable quantity and quality of resource.
• Efficiency is concerned with using the minimum amount of resources staff, drugs, laboratory services, and so on to provide a specified volume and quality of service, for example chemotherapy sessions.
• Effectiveness is concerned with whether the treatments provided chemotherapy, malignancy removal, and so on are having the desired impact, for example survival, resumption of normal lifestyle, and so on.
• Equity is concerned with ensuring, for example, that all members of the community have equal access to the services provided.

Identify two appropriate performance indicators for each of the four Es for the hospitals cancer unit. What possible conflicts may arise between these measures and how could the cancer units managers deal with these conflicts?

Make brief notes (these need be around 500 words but no more) titled: Key performance indicators for hospital unit.