The evolution of quality measurement in surgery: from standards to indicators

This paper illustrates the potential value of statistical profiles of important measures (indicators) of surgical quality as a tool for continuously improving surgical care. Review of the literature was used to identify indicators of surgical quality, and a review of experiences in using those indicators to evaluate the performance of hospitals and individual surgeons was conducted. Consensus of surgeons can identify important process and outcome measures of surgical quality. These measures can provide valid and reliable comparative data on hospital performance. Wide variations in hospital performance on many of these measures have been observed in US hospitals. These variations may represent opportunities for improving the quality of surgical care. Indicators of surgical quality, developed and interpreted by surgeons, can be valuable tools for identifying variation in the performance of hospitals and for improving the quality of care.