While quality and time are important, improving these dimensions without corresponding improvements in financial performance may be futile, if not fatal. Improving efficiency is also a vital concern. Both financial and nonfinancial measures of efficiency are needed. Cost is a critical measure of efficiency. Trends in costs over time and measures of productivity changes can provide important measures of the efficacy of continuous improvement decisions. For these efficiency measures to be of value, costs must be properly defined, measured, and accurately assigned.