Declaring financial competing interests: survey of five general medical journals.

tions. On the whole, these studies have found that published clinical indicators rarely stimulate quality improvement. 7 Our findings indicate several reasons why published clinical indicators often have little or no effect in provider organisations. A key lesson of the Scottish experience is that those responsible for designing clinical indicator systems should not only concentrate on developing robust datasets with but should also encourage a suitable organisational environment and incentive context to foster the use of these data for continuous quality improvement.