Taking action on the volume-quality relationship: how long can we hide our heads in the colostomy bag?

Abstract
There is remarkably consistent evidence that the more experience doctors or health care systems have with a procedure, the better the results. At last count, 123 of 128 published studies showed some evidence of a “volume–quality” relationship (1,2). For oncology, the evidence is mostly consistent and often provides striking examples of markedly better outcomes with higher volume (3). There is even some evidence that outcomes can be improved with standardized care and clinical practice guidelines, among other things (4).