Measuring processes of care in general surgery: assessment of technical and nontechnical skills.

Measuring the quality of health care is becoming increasingly important. Quality is often conceptualized as 3 dimensions of care: structures, processes, and outcomes. Unfortunately, there is little consensus about what should be measured--and how it should be measured--when it comes to measuring processes of care related to the conduct of surgical procedures. This article reviews recent advances in surgical quality of care measurement with particular emphasis on processes of care, and evaluates existing measures of technical and nontechnical surgical skills as measures of quality of care in surgery.