During the 1980s, the Department of Veterans Affairs (VA) received significant public scrutiny over the quality of surgical care in their hospitals. This motivated Congress to mandate reporting of surgical outcomes annually and led to the important National VA Surgical Risk Study (NVASRS) across 44 VA medical centers. In 1994, the success of the NVASRS study helped foster the development of a program for monitoring and improving the quality of surgical care across all VA medical centers, called the National Surgical Quality Improvement Program (NSQIP). As the program and its success grew, the private sector adopted the NSQIP, and subsequent studies have demonstrated similar benefits outside the VA system. The American College of Surgeons now operates and administers a parallel NSQIP program for the private sector.