The value of a Quality Assurance in an Otolaryngology- Head and Neck Surgery program, group, or department has become a necessity within most medical systems. This program will discuss the multiple roles and strategies that are needed to develop a comprehensive quality assurance program. This includes a systematic approach to complication review (Morbidity & Mortality conference), development of quality improvement projects, unit-based leadership teams, routine huddles for open communication improvement, assessment of patient feedback scores, and leadership roles in Quality. The development of such a program at an academic medical center will be used as an example. Focus will be on process improvement.