Ongoing improvement in the quality of patient care is essential to all anesthesia practices. This issue of Anesthesiology Clinics provides solid foundation and guidance in how to improve outcomes, as it covers the following topics. An overview of QI structures and initiatives is presented, focusing on the relevance to anesthesiology. A practical guide on how to implement a QI program is provided. Quality measurement approaches and issues, including the use of databases and risk adjustment are also examined. How to use simulation and other cutting-edge technology to improve quality in the OR is provided. Issues in multidisciplinary education and enhanced communication are explored. Recommendations for fostering a culture of safety are provided. How real-time support and decision-making can improve performance on quality process measures are examined. Clinical topics including bariatrics, geriatrics and decreasing perioperative delirium, and pain management are covered, as well as issues about end-of-life care.