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The health care industry does not compete on the basis of accepted, valid measures of clinical quality. Experts have argued that quality improvement should be undertaken by health care facilities on behalf of their patients and communities, not solely as an accreditation exercise. Health care quality instruments are rarely developed with the care and precision taken for granted in other industries; thus, we do not know what we are measuring. Without this knowledge, we cannot manage effectively. Even if some providers establish the reliability and construct validity of their quality measures, they are not using a common unit, making it difficult or impossible to know if we are managing the same construct or if we are doing so with the same degree of effectiveness in different settings. The orthotics and prosthetics (O&P) service delivery system urgently needs a means of measuring and enhancing health care quality given the fragmented nature of the industry. No industry-wide instrument is accepted for quality improvement. This article describes the development of the Orthotics and Prosthetics Survey (OPUS), an instrument that evaluates the typical goals of O&P providers: reduction of activity limitations, enhancing quality of life, and assuring patient satisfaction with services and devices. Widespread adoption of an instrument such as OPUS would help make quality measurement “Job Zero” in the improvement of care processes and outcomes for orthotics and prosthetic users.