The Ontario Health Quality Council and the Ontario Joint Policy and Planning Committee have co-sponsored this white paper on how to improve accountability agreements in the future. The accountability agreements are contracts that describe the expectations for agencies and organizations that plan, manage and deliver health services. The agreements identify the responsibilities of different parties and set out specific performance indicators and targets.

This white paper explores how these agreements are being used to support improved health care quality. It outlines the history of accountability agreements in Ontario and describes the experience in England with such agreements. More importantly, it presents ideas for policy makers and planners who are developing and planning future versions of accountability agreements and struggling with questions related to indicator selection and target setting. Lastly, it examines how accountability agreements could align better with overall system strategic goals, public reporting and quality improvement initiatives, recognizing that, while they fulfill different roles, their objectives overlap and they can complement each other.