INTRODUCTION Over the past decade both public attention and scientific interest have been increasingly drawn to issues of quality in health care and, in particular, issues involving patient safety and errors as revealed in reports such as To Err is Human (Institute of Medicine, 1999). Judgments regarding the quality of health care services are often made on the basis of observations about the performance of health care providers on established quality indicators; numerous examples of this can be found through the National Quality Measures Clearinghouse (Berwick, Calkins, McCannon, & Hackbarth, 2006). These judgments are commonly made after observing compliance with clinical quality indicators, such as those used by the Centers for Medicare & Medicaid Services (CMS), i.e. giving aspirin to patients admitted to the emergency department for heart attacks. For those who study the performance of health care organizations there is as much to be learned by observing organizational level outcomes as there is for the clinician in observing patient outcomes. It has been noted that just as clinicians monitor the vital measures of patient health, we should develop and monitor the indicators that inform us of the progress that needs to be made in order to reach organizational goals (Dlugacz, 2006).