Health care organizations now invest heavily—in terms of both staff time and finances—in quality and safety improvement efforts, but little data exists regarding the total costs of quality improvement programs at the organizational level. This study used forensic accounting methods to quantify the costs associated with maintaining an academic medical center's quality and safety infrastructure, including safety measurement and improvement programs. The investigators found that 1.1% of gross clinical revenues were devoted to quality improvement and safety efforts, but the largest share of expenditures went toward ensuring adherence to regulations around mandatory data reporting. A prior study conducted at the same hospital found that meeting mandatory reporting requirements for never events cost the hospital more than $8000 per case and occupied over 50 hours of staff time. The authors suggest that these findings should prompt discussion of whether the investment (in cost and time) around mandatory reporting is achieving the goal of improving safety and quality.