Pre-defined process of care and outcome metrics will be calculated using the Multicenter Perioperative Outcomes Group (MPOG) database. De-identified patient data will be extracted from the MPOG database in aggregate for the anesthesia providers to determine their overall compliance to the process of care and outcome metrics. The compliance metrics for each provider will be stored in the MPOG/ASPIRE database. Any measure implemented in production in between July 1, 2015 and July 1, 2016 will be incorporated into the analysis. The quality improvement system generates a monthly email to the provider stating their performance compared against the performance of their peers for each measure. Each measure is then hyperlinked back into ASPIRE web-based dashboard where the provider can review the cases that they failed on each measure. The visualization removes protected health information but is the representation of the physiologic monitoring, medication and fluids administered, laboratory values, and time-based events of the procedure. Provider attribution for each measure will follow existing ASPIRE specifications (available at https://www.aspirecqi.org/aspire-measures ). Each provider type (faculty, CRNA, resident/fellow) within a hospital participating in ASPIRE will be individually randomized to either receiving the electronic performance improvement email or not for a total of nine months. After the completion of the nine month randomization period, all providers will receive monthly ASPIRE performance improvement emails.