More than 30 years of research has shown that mortality rates after surgery vary widely from hospital to hospital. Surgical safety improvement has been one of the key priorities of the safety movement. This systematic review sought to identify patient care structures and process improvements that have been shown to enhance clinical outcomes of patients undergoing surgery. Among the many interventions tested, this review found that national data-monitoring and feedback programs (e.g., the National Surgical Quality Improvement Program) and reducing the number of patients per nurse improved morbidity and mortality. Other successful interventions included surgical care pathways and checklists, both of which are being widely implemented. However, the overall quality of literature in this area was relatively poor, particularly for commonly used interventions such as simulation and teamwork training.