Healthcare improvement is synonymous with quality measurement and involves assessing how well care is delivered and the results achieved in comparison with a desired standard or standards. Quality measurement has become part of routine healthcare in the developed world as a means of detecting inadequate quality performance which, if not dealt with promptly, can have far-reaching consequences as seen in recent well publicised UK examples. The growth in the use of quality measurement has led to increasing attention on the processes and measures employed—in particular how measures are chosen, reported and used. This has included consideration of the attributes that make a good quality measure using testing protocols to ensure that any potential measure is fit for purpose and using summative reporting frameworks. All of these tools are already used in some specialties outside neonatal care. This article explores this wider experience and considers how the lessons learnt might helpfully be applied to neonatal care.