This study is currently under way in Kentucky, Ohio, and Oklahoma. So far, thousands of cases have been reported to HCE by participating Kentucky hospitals, and hundreds of cases reported to QSS by its surgeons. Many standards of practice quality are being accepted and followed. A shining feature of the early observations of the pilot is how far surgical practitioners in the region exceed the anticipated norms for patient education. Collaborative meetings have been held in different parts of the state, uniformly attended by hospital representatives and a growing number of physicians, including some nonsurgeons. This study will conclude later this year and yield a significant report on the measures, standards, and capacity for ongoing improvement. It is perhaps most important to recognize that while actual data collection is unfinished, areas for improvement already have been identified. Hospital quality improvement teams and physicians are actively implementing several of these process improvement interventions. It has been said that perfection is an enemy of quality; the first step toward best practices is to implement, refine, and improve better practices.