The American College of Surgeons Committee on Trauma requires trauma centers to have a strong performance improvement program. The core of a performance improvement program is the morbidity and mortality conference. With the presenter on the hot (sometimes burning) seat, surgical complications are described, debated, and judged. The causes are analyzed, and preventability is assigned with the objective of avoiding recurrence. National programs such as the National Surgical Quality Improvement Program and quality improvement organizations purpose to improve the quality of surgical care by accurately tracking surgical complications and preventable events. However, outcomes improvement is not always apparent.1