Overall life expectancy in Canada is among the highest in the world and research evidence suggests that the healthcare system is part of the reason for this. However, patient waits, low international rankings and continued expenditure growth all provide a buttress against complacency. There can be little doubt that improvement can and must happen. Improvement depends on information, and more specifically information about outcomes of care. Without sound analysis of what works in the real world when applied to real patients, we have not done our jobs as stewards of the healthcare system. Current outcomes information in Canada is limited and tends to focus on measures of failure (e.g., hospital readmissions) rather than measures of success (e.g., improvement in functioning). Patient reported outcome measures (PROMs) must become part of regular data collection in the healthcare system. The importance of this is even more pronounced given that healthcare is now dominated by chronic conditions that need to be managed over long periods of time. We offer three recommendations for action: that we begin immediately to collect PROMs in elective surgery; that we start small-scale and coordinated experiments on the implementation of PROMs in care for chronic conditions; and that we convene a pan-Canadian working group to help coordinate and organize these activities. We recognize the challenges these issues raise, but our contention is that there are even greater challenges in continuing on as we are.