Many studies point to potential unintended consequences of accountability systems such as when schools narrow their teaching to fixate on tested subjects. As a result, some states and districts in the USA have complemented the federal test-based accountability system with additional measures of educational practices to hold schools accountable on multiple measures. To explore the consequences of such systems, this study focuses on the responses of nine elementary schools to a multiple-measure accountability system in New York City, including high-stakes tests and quality reviews. While some schools showed broader improvement efforts, results suggest the state test remains the dominant measure in driving responses of schools, and in some cases, the quality review further reinforces the schools' focus on the test.