How do we maximize the impact of the public reporting of quality of care?

Background. Many developed countries are beginning to see the public reporting of comparative information about the quality of health care as an important way of improving accountability, stimulating quality improvement and empowering members of the public. The production and dissemination of quality reports is particularly high on the policy agenda in the US and the UK, and there is now a considerable amount of experience and evidence from these countries to guide the process. Over the last decade there has been a lively debate about the balance between the advantages and problems of public reporting, but most commentators now believe it is time to cease asking whether we should disseminate information and start asking how it can be done most effectively. Purpose. To recommend ways of helping policy makers and practitioners to maximize the impact of quality reports and minimize the unintended consequences. Recommended strategies. We make recommendations about the importance of understanding the macro- and micro-environment within which public reporting takes place, of actively addressing the unintended consequences of public reporting, of incentivizing the response to the data and of engaging the public and media. The effectiveness of the different strategies, on their own or in combination, is likely to be determined by the environment within which reporting takes place. Conclusions. It is not desirable to look for a common 'fix' applicable to all organizations or transferable across all international boundaries. However, in this paper we describe lessons that we think are common to all countries attempting to produce and disseminate health care quality reports.