In the last decade, healthcare has seen a much greater emphasis on quality, safety, and value. It is anticipated that this emphasis will continue, including a change to reimbursement models that emphasize value rather than our current system that emphasizes volume. One option to improve value is to decrease unexplained clinical variance. For example, different surgeons at the same institution may have markedly different ways of treating the same problem. Especially if the costs differ greatly, the institution, patients, and payers naturally want to know if the different treatment algorithms promote improved quality. Pediatric Orthopedic Surgeons, especially those in training or early in their careers need to understand the reasons for this emphasis on quality, and how it is likely to affect their practices.