Some argue that the way to improve the current health system is to ask patients about their experiences and perceptions of whether specific interventions (e.g., surgery) achieve expected health outcomes. Others argue that the way to improve health outcomes is to reform the system, particularly for those patients who suffer from complex chronic diseases and symptoms that do not fall neatly into a clinical pathway. I argue that patient reported outcome measures based on our current healthcare delivery system are necessary but not sufficient to improve patient outcomes. Ongoing dialogue, leadership and action are urgently needed to achieve a preferred future where our silo/sector/disciplinary based health system is reformed into an integrated person-centred system.

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