The aim of this study is to understand the Quality improvement national registries provide structured, clinically relevant outcome and process-of-care data to practitioners—with regional meetings to disseminate best practices. However, whether a quality collaborative has an impact on processes of care is less clear. We examined the impact of a statewide hospital collaborative on adherence rates to best practice guidelines in vascular surgery. A large statewide retrospective quality improvement database was reviewed for years 2013 to 2019. Hospitals participating in the quality collaborative were required to submit adherence and outcome data and met semiannually, incentivized by a pay-for-participation model. Aggregate adherence rates among all hospitals were calculated and compared. Thirty-nine hospitals participated in the collaborative, with attendance of surgeon champions at face-to-face meetings of >85%. Statewide, hospital systems improved every year of participation in the collaborative across most best practice domains, including adherence to preoperative skin preparation recommendations.