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A robust quality improvement (QI) program is an advantage for any anesthesia practice, whether private or academic. Although the primary goal should be ongoing improvement of patient care, QI infrastructure also enables the group to demonstrate value to external stakeholders ranging from the federal government to commercial payers to local hospital administration.The QI program enables efficient management of the operating room, response to patient and surgeon complaints, and submission of public performance measures to the Centers for Medicare and Medicaid Services (CMS). A robust QI program supports the professional obligation of anesthesiologists to continually improve the safety of patient care. The QI program creates the measuring stick for improving outcomes over time, both for the group as a whole and for individual members. Collection and analysis of adverse events allow every provider to learn from the experience of others and create a substrate for improving systems of care within a "safety culture" of open and honest discussion protected from legal discovery or public embarrassment of the hospital, the practice, or any individual. The anesthesia QI program will support the health system's goals related to Joint Commission, Leapfrog, and other reportable patient safety initiatives, providing value to the relationship.This chapter reviews the steps involved in the creation and support of an anesthesia department QI program, including suggestions for data collection, incident analysis, and reporting. The goal is a department in which every member participates in Continuous Quality Improvement (CQI) as an expected clinical activity. 1 Institutional supportA robust QI program begins with commitment from senior leadership. Quality and performance data are required by the hospital system to meet regulatory requirements, and good performance is tied to incentive pay for hospital leaders. The hospital will ask each department-including anesthesia-to support their global efforts. An effective anesthesia QI program offers a competitive advantage: Groups that measure their performance are best positioned to improve it and can use the resulting data to win and maintain hospital contracts. 2 Department Chairs are more willing to invest in QI than in years past, but more than money is required. Senior leaders must make it clear by their actions that participation in QI is professionally valuable, and the Department Chair can emphasize this by selecting the right person to be the QI Director and then mentoring them in the role. Senior clinicians must be willing to acknowledge and discuss their own adverse outcomes and must model the willingness to change practice when needed. Not every member of the group must attend hospital meetings or review adverse outcomes, but those who do must be supported by their peers who stay in the OR. As the saying goes: "If you're not at the table, you're on the menu." Participation in hospital QI meetings is as important to practice viability as providing good clinical service-something...