Public reporting makes accountability possible

This paper reviews the meta-analysis of Brown, Bhimani and MacLeod and finds it an important contribution to the literature on performance reporting (PR) in healthcare. Of 1,053 papers identified in their search, only 62 met their criteria for inclusion in the review. The authors used a Knowledge, Attitudes and Behaviour (KAB) model for their analysis. Of the 63 papers reviewed, most related to individual consumers and groups of providers, fewer related to groups of consumers and individual providers. The principal findings were that there is a shortfall in the literature on PR to 2004 and limited evidence that PR is having any impact on KAB of consumers or providers. They appropriately conclude that there is a need for the development of a conceptual model and thereby the requirement that the goal of placing PR "within a context that focuses attention and that supports action" may be achieved. In general, the conclusions are defensible and, given the lack of impact of PR they have demonstrated, their work should stimulate response and action within healthcare systems. Finally, this paper concludes by proposing six characteristics of successful PR--clear definition of context and goals, objective and verifiable indicators, transparent and useable information, equitability in scope, engaging the continuum of care, and integrating measures of cost-utility.