In 1985 our review article entitled “Monitoring: Surveillance for Nosocomial Infections and Uses for Assessing Quality of Care”’ began with a 1978 quotation from Avedis Donabedian: . . . We have granted the health professions access to the most secret and sensitive places in ourselves, and entrusted to them matters that touch on our well-being, happiness, and survival. In return, we have expected the professions to govern themselves so strictly that we need have no fear of exploitation or incompetence. The object of quality assessment is to determine how successful they have been in doing so; and the purpose of quality monitoring is to exercise constant surveillance so that departure from standards can be detected early and corrected.2