The use of quality indicators to promote accountability in health care: the good, the bad, and the ugly.

In Canada, we place significant cultural and financial value on our healthcare system.  As such, it is imperative we measure its quality.  In this commentary, we highlight some of the potential benefits and harms associated with measuring quality using currently available indicators, such as hospital mortality rates, emergency department length of stays, and readmission rates.  These measures tend to focus on provider and process issues rather than patient outcomes and also reflect what we can measure rather than what we should measure.  We argue that the current approaches are inadequate and recommend a better understanding of the limitations of current indicators and more provider engagement.  To meet these recommendations the health system needs to increased investment in performance measurement systems.