Quality is being measured and reported across healthcare organizations and sectors, but efforts are rarely made to connect the activity in one organization to quality experienced by patients and clients in another part of the healthcare system. This article describes one regional health organization's journey to measuring health quality at a system level. The authors describe a highly consultative and iterative process used to measure quality across the continuum of care, and the challenges experienced in approaching this type of measurement, and they highlight some of the early findings.