In New York State, a risk-adjusted outcomes system has been used by the Department of Health to monitor all cardiac operations since January 1989. Hospital-specific and physician-specific results are published annually. In this report we describe the experience of one hospital in New York State whose results showed a higher than expected surgical mortality. Staff reactions were initially skeptical, and case reviews found no quality-of-care problems. However, a different approach using statistical analysis of the detailed case-specific outcomes data was more revealing. The excess mortality was localized to patients having high-acuity, emergency coronary artery bypass grafting, particularly those who had suffered a preoperative acute myocardial infarction less than 6 hours before, those who were in shock, or those who were in a hemodynamically unstable condition. The staff responded with a focused effort to optimize the management of these patients, resulting in zero mortality for emergency coronary artery bypass grafting during the following year. In the process, staff from all departments joined together in a more collaborative approach to the cardiac surgery program. Outcomes data can be useful for effecting program improvement if comparable norms and open access for flexible analysis are available.