This study evaluates the relationships among the average number of procedures per surgeon, calculated across the entire hospital, and multiple dimensions of overall hospital operational performance. Hospital administrative data from 154 public and private hospitals in the state of New York were augmented by data from the Centers for Medicare and Medicaid Services. The data included administrative surgical records across all clinical areas for the year 2009.

Health care spending comprised 17.9% of the United States Gross Domestic Product in 2012 (World Bank, 2014). However, the quality of health care in the United States is only ranked as "fair" by the Agency for Healthcare Research and Quality (Agency for Healthcare Research and Quality, 2014). An analysis by the Commonwealth Fund ranked the quality of health care in the United States fifth among eleven developed countries in 2011, despite per capita health care spending of $8508. That level of spending was 50% greater than that of the second highest spending country (Norway), and more than twice the per capita spending level of the country ranked first in quality (United Kingdom) (Commonwealth Fund, 2014). While there is not universal agreement on the validity of health care quality country rankings or assessments, it is clear that the much greater level of costs incurred to deliver health care in the United States has not provided correspondingly higher levels of quality. Therefore, identifying factors that are related to better cost performance or quality performance, or better yet, both, is worthwhile.