In the current climate of public accountability, many clinicians have become uncomfortable with any efforts to create measurement systems. That is unfortunate because measurements are absolutely essential to efforts for improving the processes of medical care. In their guideline implementation and measurement efforts, ISCI and the IMPROVE Project in Minnesota have gradually learned how to distinguish between measurement for improvement and that for accountability. Both approaches are different from the approach that physicians are used to in their encounters with medical research. Understanding these differences and respecting the confidentiality of individual medical groups has been crucial to moving past confusion and suspicion to genuine improvement actions involving multiple medical groups and their contracting managed care plans.