Health care leaders increasingly focus on improving the quality of surgical care through implementation of bundles, or checklists that encourage compliance with evidence-based processes of care. In a timely and important study, Anthony and colleagues provide high level evidence of the potential dangers of this type of approach. The authors conduct a single-center randomized clinical trial to reduce SSI after colorectal surgery by mandating adherence to 5 practices that have previously been shown individually to be effective in this regard. Contrary to expectations, patients in the intervention arm developed significantly more wound infections.