This case considers the challenges, benefits, and costs of hospital participation in a widely recognized surgical quality improvement benchmarking program. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) issues performance reports twice a year to participating hospitals, creating benchmarks based on data submitted by over 500 hospitals. NSQIP claims that participation reduces surgical complications.  

The protagonist, the Chief of General Surgery at a large academic medical center, faces skepticism about the value of the report on two fronts: from some surgeons on his staff and from a statistician he consults. Some of the hospital surgeons find the data difficult to interpret, and question their utility in focusing quality improvement interventions. The statistician has reservations about the validity of the statistical results as a basis for action. The chief must decide if and how the NSQIP report can be used to improve quality. In the coming era of value-based purchasing initiatives for hospitals, the chief also needs to be concerned about how payers might interpret this data as they develop payment systems that reflect available measures of surgical quality.