The article seeks to appraise performance appraisal system (PAS) effectiveness in Thika county hospital in regard to adherence to standard operating guidelines and utility of PAS information. A descriptive cross-sectional research design was used.196 respondents were drawn from a population of 400 eligible participants using proportionate random sampling for staff clusters and systematic random sampling for individuals. Data was collected using a semi-structured questionnaire, Key informants interviews and focused group discussions. The response rate was 88.2 %( n=173).77.5 %( n=134) were female, 61 %( n=104) had diploma qualification as highest level of education and 71 %( n=122) were in job groups ‘K’ to ‘N’. Regarding adherence to PAS process, 83.7 %( n=142) were not familiar with PAS policy, 71.4% (n=122) were not familiar with annual work plan, 76 %( n=130) never set plans at start of year, and 94 %( n=160) never did midyear reviews. Majority 90 %( n=155) however did end of year reviews. Majority, 80.9 %( n=140) felt due process is not followed. In exploring PAS information utility, 68.6%9(n=105) say it should improve services but currently, 83.2 %( n=144) feel it’s just a routine procedure. The hospital has reward system which does not follow PAS principles. None of those scored excellent received bonus salary reward nor were there any report of sanctions. Staff development considerations are at the discretion of managers mainly considering departmental needs rather than individual development needs. Majority; 84.1 %( n=143) believe PAS has not improved hospital performance. There were no statistically significant variations across staff clusters regarding perceptions of following due process and whether PAS helps one do their job better. In conclusion, most PAS steps are missed. Either it’s not a reference point for personnel decisions. The study recommends that the hospital designate office responsible for PAS, and design software to capture PAS data for reference in decision making.