With widespread recognition that surgical outcomes vary by provider, surgeons and hospitals are increasingly being asked to provide evidence of the quality of care that they deliver. Patients and their families are turning to the Internet and other sources to make better informed decisions about where and by whom to undergo surgery. Both public and private payers are looking to steer selected populations of surgical patients to high-quality providers—so-called value-based purchasing. To meet these interests, policy makers, health services researchers, and a variety of related organizations have redoubled their efforts to develop and implement quality indicators germane to surgery.

 Thompson RE: Next steps in implementing quality appraisal / action plans in hospitals. Oak Book, Thompson Mohr and associates Inc., 1980