Quality in otolaryngology: where we have been and where we are going.

The patient safety and quality improvement era began in 1999, and it has exploded in otolaryngology in the last decade. Although there have been some successes, it is not clear that, overall, otolaryngology is much safer than 15 years ago. We discuss why a prolonged lag between improvement efforts and improvements is not surprising and how the safety and quality movement is likely to evolve in the upcoming years.