The routine measurement of outcomes of hospital care has strong methodological and organizational requirements. Since the initiation of a comprehensive quality project in 1996, the Health Authority of the Canton of Zurich gained valuable experiences with the development of patient-oriented outcome indicators and benchmarking of results. The report describes this project in detail, its method of working, as well as the process and results of development, measurement and implementation of indicators. The presentation of the theoretical framework and methodological lessons learned is supplemented by a number of case-studies and key experiences with data collection and benchmarking. Issues of policy integration, compensation, and improvement activities that were established as response to outcome data are summarized and readers are provided practical advice and pragmatic recommendations for large-scale outcome measurement.