The book begins with an introduction to the main research themes that investigators are currently pursuing. Dr. Chang (Chap. 2) provides an overview of comparative effectiveness research and describes how this field goes beyond randomized clinical trials—which represent only a narrow part of the field. He describes the spectrum of study designs (e.g., pragmatic trials, observational studies) available for assessing which treatments are most effective, and how effectiveness may vary across different patient and provider subgroups.

As described above, HSR often asks questions much more broadly than traditional clinical research, including investigating differences in practice style and treatment across large areas and understanding how these are shaped by healthcare policy. Dr. Goodney (Chap. 3) provides an overview of the seminal work done on variations across geographic areas by the Dartmouth Atlas group that opened our eyes to wide, unwarranted practice variations in the United States. Dr. Dimick (Chap. 4) then discusses the importance of taking a broad perspective in evaluating how health care policy research can help improve the context in which we work by critically evaluating the incentives and structure that are largely invisible, but shape our daily work. Dr. Haider (Chap. 5) considers the inequities in our health care system that lead to disparities in use and outcomes of surgery. He emphasizes that the field of disparities research needs to move beyond documenting quality gaps, and, instead, begin fixing them.

Another important focus of HSR is on measuring and improving quality. Dr. Bilimoria, a leader within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), describes the field of quality measurement, including the pros and cons of the structure, process, and outcomes that are used as performance indicators (Chap. 6). Dr. Wong, who serves as an Associate Chair for Quality at her institution, then discusses how these quality indicators can be used locally to improve care (Chap. 7).

We next consider several emerging areas within HSR that are likely to become integral to our field within the next 5–10 years. While many of these fields are well-established outside surgery, only a small number of investigators are pursuing these within our profession, creating a large opportunity for young surgeon-scientists.

Dr. Kao (Chap. 8) describes the field of implementation and dissemination research. Implementation science explicitly recognizes the gap in translating evidence into practice, providing a rich set of theoretical frameworks and research tools to rigorously study barriers and facilitators of the adoption of evidence in real-world settings. Building on this knowledge of the importance of “context” in optimizing healthcare, Dr. Ghaferi (Chap. 9) examines the important role organizational culture plays in creating well-functioning environments that are safe and favorable to successful adoption of best practices.