Health care workers agree that it is necessary to improve the quality of health care for Australian patients by designing systems to avoid the risk of preventable harm. An important component of such a system is the capacity to measure, monitor and act on health care performance data. This is the current focus of health care reform around the world, including Australia. Health care quality can be measured by a variety of methods. In response to slower than anticipated health care reform, there is increasing interest in the use of nationally defined standards, which could be subject to mandatory external reporting and remedial processes. Here, we consider the issues that are likely to arise if national standards are to be developed and implemented in Australia, and provide a model for developing the standards.