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The purpose of the paper is to evaluate the development and use of service level agreements (SLAs) in a Belgian hospital from a client's point of view.

The paper is based on a theoretical framework indicating the variables that influence the relationship between the use of a specific governance mechanisms and performance, a new instrument was developed and applied on a convenience sample of 107 SLA clients from a Belgian hospital.

SLAs are useful for hospitals, as they improve people's insight into processes, stimulate people to think about performance measurement and, in some cases, also lead to improved services. The main advantages of SLAs do not really lie in improved relationships and better fits with clients' needs, but in improved process mapping and improved performance measurement. The questionnaire from this research study proves to be a useful and reliable instrument for evaluating internal SLAs from a client's point of view.

The results of this study are limited, as they are only based on one Belgian institution. Other limitations include the posttest‐only research design and the unequal distribution of the respondents over the different SLAs. Recommendations for future research include applying the questionnaire in other Belgian hospitals and in settings where both a pretest and posttest can be conducted.

As far as known, no other studies have yet evaluated the effectiveness of SLAs in the healthcare sector. While a fairly‐substantial amount of scientific literature deals with SLAs in the world of ICT, this literature is often very specific and cannot always be applied to other service sectors.