It is sometimes difficult for surgeons(or any clinician)to define quality of care—particularly as a policy measure.In practice,we tend to know it when we see it(or when we do not),but there are still controversies as to what is and what is not quality care.For example, should high-quality care be defined as state-of-the-art care? Reasonable care? Or given the trend toward levels of evidence, should high-quality care be only evidence-based care?