In the lead article, Penfold et al. question whether the hospital standardized mortality rate (HSMR) is a valid indicator for hospitals to use in addressing patient safety. Their article attempts to show that the HSMR is flawed and should not be used as an indicator for patient safety; however, the rationale presented fails to address the real issue found within the Winnipeg Health Authority. A hands-on approach to sorting through the data can reveal internal issues and spur quality improvement.