In today’s era of evidence-based medicine, personalized and value-based care have become critical goals. Seeking to attain these goals amid skyrocketing healthcare costs, preventable errors have become a target for the quality improvement and patient safety (QIPS) movement. For surgeons, in particular, this has resulted in a constantly changing playing field requiring the balance of patient safety and outcome concerns along with institutional pressures and cultural shifts. This chapter presents a clinical case scenario to illustrate current situations pertinent to the use of quality improvement and patient safety . Relevant history is reviewed from its foundation with Ernest Amory Codman at the turn of the twentieth century to the development of the Joint Commission on Accreditation of Healthcare Organizations and the National Surgical Quality Improvement Program. Subsequently, the current framework and methodologies for QI, such as continuous process improvement and the plan-do-study-act model, are reviewed, along with research applications. The chapter concludes with a discussion on the broader healthcare cultural and practice implications of moving toward a blameless, evidence-based QIPS arena.