Anesthesiologists occupy a pivotal position at the intersection of clinical care, hospital operations, and regulatory compliance. This chapter examines their evolving leadership role in ensuring institutional adherence to complex federal, state, and accrediting body standards—spanning the Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), Det Norske Veritas (DNV), and other accrediting organizations. Drawing upon the anesthesiologist’s systems-based perspective, the chapter highlights how the specialty contributes to patient safety, quality improvement, and operational excellence across perioperative services and the broader hospital enterprise. Through expertise in infection control, emergency preparedness, and data-driven performance improvement, anesthesiologists serve as critical partners to administrators during accreditation surveys and policy development. The chapter explores how anesthesiologists integrate ASA standards, lead Quality Assurance and Performance Improvement (QAPI) initiatives, and participate in developing policies that align with National Patient Safety Goals. Their engagement transforms compliance from a bureaucratic requirement into a continuous improvement process that advances patient outcomes, institutional resilience, and the overall culture of safety.