Performance measurement is now a reality for clinicians around the world. It involves measuring and monitoring quality of care using standardised indicators. Shortcomings in the quality of care—the gap between what we know and what we do—are well documented.1 So too are inequities in access, quality, and outcomes linked to gender, ethnic origin, and socioeconomic status.2 Recognition of substandard and uneven quality of care has fuelled calls for providers to be more publicly accountable and for health systems to change.

Interest is growing in performance measurement as a way to drive improvements in health care. In this week's BMJ, McDonald and colleagues describe an ethnographic case study in which two English general practices changed their organisation to achieve high performance scores under the quality and outcomes framework.3 The quality and outcomes framework, and other high profile measurement and reporting efforts such as those in the US Veterans' Health Administration, have met with some early success.4 5 Adding to this enthusiasm is a recent …