Earlier this Spring, I had the opportunity to attend the fifth annual conference of HEALNet in Toronto and join with presenters and delegates in assessing the utility and effectiveness of health report cards across Canada. The HEALNet conference brought together presenters from Canada, the US and Europe to debate the use of reports cards in health care as a means to both measure and assess the performance of the healthcare system. HEALNet is the Health Evaluation Application and Linkage Network, a Federal initiative bringing together academic, government and private sector partners, who share a commitment to the use of evidence-based knowledge and technologies to improve health-related, evidence-based decision-making in the health system and in the workplace. Applications focus on planning, funding and delivery decisions at the clinical, administrative and policy levels.

The conference focused on two themes: Accountability for Performance, and Approaches to Measurement in Healthcare. While conference organizers differentiated between these two aspects of our healthcare system, I found that presenters referred to these topics interchangeably: measurement is about accountability and accountability is about measurement. Differences in perspectives (not that there were many) seemed more related to role in the system, stakeholder or target audience, be they academic, policy, consumer, media, provider or custodian of the data (CIHI and others).

Ross Baker, from the University of Toronto, gave a presentation on the types and applications of four models of measurement that predominate: practice atlases, report cards, balanced scorecards and clinical value compasses. He highlighted the respective applications, benefits and pitfalls of each and offered his commentary on lessons learned.

The conference examined accountability from several of perspectives. Can accountability be achieved through compliance with minimum standards, public awareness (e.g., the Maclean's' report on healthcare), specific performance disclosures through voluntary report cards/mandatory bureaucratic processes or media attention? We heard that consumers have their own indices (placing more confidence in professional behaviours and self-regulation) which have been difficult to measure because data sets have not been organized for that purpose. Accountability and performance are often in the eye of the beholder!

Measurement processes, tools and data, however, are burgeoning and new responses to old questions are grounded in healthcare. As the information age infiltrates healthcare delivery, its management and planning can be achieved with greater precision, pioneering a new genre of accountability. How do we differentiate between passing interest and true performance indices? While the Maclean's' report and other popular approaches catch selected (reader) demographics, balanced score cards and other measures focus on enlightened providers and structured methodologies. However, one speaker reported how media attention drew public attention to one issue (excessive wait times) diverting resources from clinical activities less sensitive to public opinion.

In collaboration with a range of partner organizations, HEALNet is sponsoring important work in developing measurement tools that will be the backbone of accountability and hallmark of excellence in healthcare. Many tools, like the data sets that they rely upon, remain in their infancy. But with each iteration, as data sets and their applications improve, "old system" approaches will yield to new discoveries and the system will, like a ratchet, move one-step forward. Performance measures are dynamic and the framers of this new accountability are comparing data, their applications and trends. Like the sextant superceded by GPS, new instruments are changing the landscape of performance management and system accountability in healthcare and HEALNet partners are its architects.

As my mother used to reflect on my scholastic results, "Marks are important as long as you're improving and getting 'A' for effort." That sentiment is equally valid for healthcare report cards. Through competition for resources, public awareness, consumer choice, objective measures or media coverage, the healthcare system will require performance management and its sponsors, the Canadian public, will expect no less effort from its leadership.

Thank you to Hospital Quarterly for the opportunity to attend the HEALNet Conference and to comment on my observations. Thank you, too, to the many people at HEALNet and its partners, for sponsoring such pivotal work in performance measurement of Canada's healthcare system.

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