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We agree completely with Dr. Hébert’s position that performance measurement should be a major priority.1 He poses the question: “So why do measuring performance and health outcomes elude us?” We suggest an additional reason not mentioned by him —measuring quality of care is complex because it is a vague concept that means different things to different people. As a result, different groups derive different indicators. Health systems need to be strategic in moving this agenda forward. We recommend four investments, which we predict will have a large and synergistic impact. One, there should be increased investment in information management technologies that can support performance measurement. Two, there needs to be enhanced training of statisticians, epidemiologists, economists, clinicians and managers to use the clinical data to support informed decision-making. Three, there needs to be increased funding to support thoughtful evaluations of innovations designed to improve quality of care. Four, we need to support collaborations among health system institutions.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/3/225#292480