A New York Times article (Sept 14, 2011) summarizes a report (http://www.documentcloud.org/documents/249296-joint-commission-report-on-quality-and-safety.html) that measures compliance to established protocols to treat diseases like heart attack and pneumonia.  The interesting outcome is that several reputed large hospitals did not make the list of the 405 hospitals that had a 95 % score of compliance.  Should hospital quality be measured as compliance with protocol ? Should large hospitals that deal with more risky patients be penalized for lack of compliance with established treatment protocols ? Or should outcomes be balanced along with compliance to measure quality ?