Behrooz - they are both equally important and inter-related. An effective health service/institution will have high levels of efficacy in terms of striving for quality of care and standards. You can add other inter-related factors as well - such as efficiency, equity etc.

Dear Dean

Thank you for your response. I agree with you that we need to focus on both (the efficiency and effectiveness) at the same time.

In effectiveness we focus on outcomes (outcomes such as patient recovery, patient satisfaction), while in efficiency, we focus in consuming less resources (such as capital and human resources). Focusing on effectiveness requires consuming more resources that reduce efficiency. Conversely, focusing on efficiency is associated with a reduction in the consumption of human and capital resources, which usually reduces effectiveness. It is natural that if we do not have resource constraints, it is better to focus on effectiveness in order to provide quality and standardized care services. But we are often faced with resource constraints in health institutions in developing countries. In such cases, managers inevitably focus on efficiency. Naturally, this will reduce the effectiveness and decrease the quality of service.

I would also consider accessibility, such as, the ability for people to access necessary healthcare services in a timely manner, to also be an important outcome. This too creates trade-offs between accessibility, efficiency and quality of healthcare services.

How these should be prioritized will differ depending on your role. Patients will value different outcomes to hospital administrators.The right balance between these three often competing outcomes is a meaningful challenge.

Both, effectiveness addresses the mortality aspect while efficacy addresses the morbidity aspect to any intervention, accessibility is the road on which both travel

Dear David Lyell

Thank you for your response. I agree with you. Hospital managers are always faced with a great challenge. The challenge is to focus on which managerial goal? the efficiency, or quality and effectiveness of services? The restricted resources guides managers towards efficiency, Whereas social responsibility drives them to quality. But how can they balance the two contradictory areas?

Efficacy versus Effectiveness in Health Care Institutions

Efficacy or Efficiency?

Efficacy literally refers to inherent capacity to function or simply to be effective. Efficacy is a probability of being effective due to resources that has been or to be put in place. Such include satisfactory environment, qualified personnel, equipment and well validated standard procedures including Guidelines. Efficacy is a process towards being effective. It is like hypothetical case or experimental. It is an important prerequisite for effectiveness.

Effectiveness is the real world senerio where certain parameters have been added to efficacy. In other words the practical reality that depicts the funtionality of efficacy is the effectiveness. Adequate implementation of efficacy can only be assessed through effectiveness.

Another senerio to broaden our understanding is what happens to drugs being developed. Observed funtionality of drugs during clinical trials in a controlled or ideal environment is efficacy while the observation in the real clinical settings is effectiveness. Efficacy answers the question 'Can it work' Effectiveness answers the question ' Does it work'

The Health Care Institutions need to focus in both. Without efficacy, there would never be effectiveness. Efficacy must be put in place first. This if properly implemented would guarantee effectiveness. Well implemented efficacy gives rise to effectiveness.

Efficiency is the ratio of output or outcomes relative to the input- the resources expended. The higher the output as compared to the input, the more efficient is the system.

A well implemented efficacy processes and procedures must consider efficiency along the effectiveness which also means COST-EFFECTIVENESS. This is imperative to ensure SUSTAINABILITY of attained level of QUALITY delivery.

Institutions strive to ATTAIN, MAINTAIN and SUSTAIN quality services. To acheive this, proper processes and procedures using qualitative personnel and equipment (Efficacy) need to be put in place. Properly implemented efficacy would acheive effectiveness, at the same time, it would address efficiency. In the overall the SUPERIOR PERSPECTIVE IS THAT OF COST-EFFECTIVENESS. Efficacy and Effectiveness should not be viewed in isolation relative to efficiency.

Thank you Dr. Ismail Ayinla Suleiman for complete reponse. I mean the comparison of Efficacy and effectiveness in this thread. Of course, I agree with you that hospital managers should focus on both at the same time. But I believe it is very difficult to achieve Efficacy and effectiveness at the same time. I believe that focusing on effectiveness is a top priority in health institutions. In the second step, of course, we need to focus on Efficacy and try to make all activities cost- effectiveness.

Thanks for the compliment. It is highly encouraged and strongly recommended to check and established the working meaning of the two concepts. Efficacy is just ability to make the real thing happens while how successful is measured using effectiveness.

In case of institutional hospital one should focus on overall effectiveness of services. In individual sector or branch is considered efficacy should be focused to maintain total effectiveness of all services

Dear Dr. Prasanna s Mathad

I agree with you in first part. The focus of organizational activities on health institutions should be on effectiveness. But at the individual level I think we need to focus on effectiveness and efficacy at the same time. Focusing on efficacy may keep us away from service effectiveness. If you have an argument for your comment please share.

Dear Dr. Rezaei,

Salaam

In response to your question, I would like to respectfully emphasize that, on the basis of principles of systems engineering, it is important to first differentiate the system efficiency from system evaluation. By definition, system efficiency is concerned about how well a system (here it is a health and care system) can satisfy all functional requirements defined for the system. But, on the other side, system effectiveness is interested in knowing about the probability of success in fulfilling each of the functional requirements of the system. In other words, nature of system effectiveness is probability, however, nature of system efficiency is quality terms. Now, you should ask you that which of them you are interested in.

According to language of systems engineering, the above take you a set of measures referred to as "Figures of Merits (FoMs)". The fact is that once you are interested to study performance or productivity of your system, both of them have to been addressed and analyzed.

Hope the above helps,

Ali

Dear Dr. Rezaei,

Salaam

In response to your question, I would like to respectfully emphasize that, on the basis of principles of systems engineering, it is important to first differentiate the system efficiency from system evaluation. By definition, system efficiency is concerned about how well a system (here it is a health and care system) can satisfy all functional requirements defined for the system. But, on the other side, system effectiveness is interested in knowing about the probability of success in fulfilling each of the functional requirements of the system. In other words, nature of system effectiveness is probability, however, nature of system efficiency is quality terms. Now, you should ask you that which of them you are interested in.

According to language of systems engineering, the above take you a set of measures referred to as "Figures of Merits (FoMs)". The fact is that once you are interested to study performance or productivity of your system, both of them have to been addressed and analyzed.

Hope the above helps,

Ali

Dear Ali

Thank you for your participation in this discussion. Of course, both efficiency and effectiveness are important in managing a system and should be considered by managers. But the point is that depending on the specific circumstances and in some cases a manager must choose between effectiveness and efficiency . Which health care systems should we choose and focus on under such conditions?

Dear Ismail Ayinla Suleiman

Thank you for your participation in this discussion. I agree with you. Efficacy describes the technical relationship between the technology and its effects (whether it actually works), whereas effectiveness concerns the extent to which application of an efficacious technology brings about desired effects (changes in diagnoses, altered management plans, improvement in health)…Efficiency is an economic concept which relates efficacy and effectivness to resource use. Assessment of efficiency is concerned with whether acceptable efficacy and effectiveness are achieved with the most prudent or optimal mix or resources.

Dear Dr. Rezaei,

Salaam

First of all, I would like to sincerely thank you for all your kind words.

To be honest, I am not confident enough I have understood you question well as you have not specified clearly what condition you are thinking about. However, as a response in this message, I would like to respectfully emphasize the critical point I addressed in my previous message, the subtle difference between “system efficiency” and “system effectiveness”. As I mentioned previously, system efficiency is concerned about how well a system can satisfy all functional requirements defined for the system. Concerning the system efficiency, you could be interested to know about “time”, “cost”, “accuracy”, “tolerance” “variation (variance)”, and so forth related to all key variables or requirements of your system. But, on the other side, system effectiveness is interested in knowing about the probability of success in fulfilling each of the functional requirements of the system. In fact, the probability of system success to finally meet the target value specified for each of the critical variables or requirements defined for the system. In other words, nature of system effectiveness is probability, however, nature of system efficiency is quality terms. Now, on the basis of the definition and description presented above, here you can say that which of them (efficiency or effectiveness) is more interested for you with regard to the problems and challenges you are dealing with.

Hope the above can helps you!

Sincerely,

Ali

Dear Dr Ali Mollajan, many thanks for your complete response in this issue. I appreciate it so much.

Best

Behrooz

So far I know effectiveness is a part of efficacy....just manage anything in a cost effective way calls efficacy. So manager should be efficient, then you can get two by one.