Forster, A. J., & van Walraven, C. (2012). The use of quality indicators to promote accountability in health care: the good, the bad, and the ugly. Open Medicine, 6(2), 75–79. Available from: http://www.openmedicine.ca/article/view/497/465

Excerpt:

In this commentary, we hope to stimulate innovation in the field of health care performance measurement. We will discuss several considerations regarding the use of three quality indicators that are commonly used to improve accountability in the Canadian context. Specifically, we will focus on the hospital standardized mortality ratio (HSMR), all-cause urgent readmissions, and emergency department length of stay (ED-LOS; see Textbox 1). We discuss “the good,” “the bad,” and “the ugly” to illustrate both positive and negative consequences related to measurement. We conclude with specific recommendations regarding investments to improve quality measurement.