At the conclusion of the HEALNet conference, held in Toronto in April, a special session was held to assess the current status of health report cards. Sponsored by Microsoft Canada and the Canadian Institute for Health Information (CIHI), the session involved the use of handheld interactive response devices, which allowed participants to assess whether report cards are making the grade.

There were 130 participants in the session, representing all parts of the country. University and research institutes were identified as the site of employment for 40% of the respondents, and the same proportion worked in government and health service delivery organizations. The remaining participants were from the private sector, consulting companies and other sectors. Thus the respondents represent a good mix of research 'producers' and 'users.'

An overwhelming majority, 91% reported having read a health report card in the past year, and 58% had been involved in their development. Respondents viewed report cards as being essential for accountability in the health system (60%), and for improving the quality of health services (60%), but less important for improving the practices of clinicians (28%).

Contrary to the efforts of MacLean's magazine, 86% of respondents felt that it was not possible to create a single measure of performance for healthcare organizations. There was clear agreement (79%) that health report cards should be produced by independent bodies such as a Quality Council or a Health Auditor-General. Only 30% thought they should be produced by funders, and 24% by the organizations delivering health services. There was clear disagreement with the idea that report cards should be produced by the media, with only 9% supporting this notion.

While most respondents, 79% felt that health indicators should be evidence-based, only 38% felt that current indicators actually were evidence-based. A scant 9% believed that existing measures of clinical performance were a good summary of the quality of healthcare in Canada. Respondents viewed existing report cards to be more useful for senior managers in the health system (65%), than for line managers (31%) or funders (39%). Only 17% viewed them as of use to individual practitioners and 21% for consumers.

The final question asked respondents if health report cards are making the grade. None recorded a grade of 'outstanding', while only 9% reported 'adequate'. Most respondents, 79%, felt that report cards were in the 'needs improvement' category, while 12% felt that they actually had a grade of 'fail.'

There seems to be some agreement on the need for health report cards and how they may best be produced. However, there is clearly concern about the adequacy of current report cards, and their relevance to different stakeholders. The results of this report card on report cards show the need for more collaboration between researchers who are developing indicators and methodologies for report cards, and the users of such report cards, who are going to need to implement their results. The development of such collaborations represents a fundamental component of the HEALNet research agenda.

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