Postoperative complications are expensive. Quality improvement programs require a nuanced understanding of the risks of surgical complications in order to design effective strategies to reduce risks and lower costs. Motivated by pressure to control overall health care spending, third-party payers are increasingly linking reimbursement to quality indicators and process measures supported by outcomes research. For this approach to be fully embraced, all parties (patients, providers, insurers, hospitals, the government, and the public at large) must have confidence that the underlying data are reliable, valid, and robust. Thus, the Michigan Surgical Quality Collaborative, which represents 22 participating hospitals, the American College of Surgeons, and the dominant third-party payer in the state, is a noteworthy alignment of entities that might otherwise have differing perspectives and vested interests.