My first encounter with Quality Improvement, was when I was a Scrub sister working in theatres; My theatre was chosen to be a test site for implementation of the productive operating theatre. What I learnt from this is that small changes can have a resounding impact on not only efficiencies but team culture and most importantly patient safety. We implemented what seemed like easy solutions to our problems:- 1. Team briefs and De briefs 2. 5's to storerooms 3. Patient Status at a Glance boards 4. A data board 5. Human Factors training Simple, I hear you say! The key to improvement was, as I often find in my QI role, communication! The increased channels of communication, and broken down hierarchies, meant we became a better functioning team. Safety for the patients increased, equipment issues became a thing of the past and as a result team culture changed for the better. We became a team as a whole, no longer separate silos of nurses, consultants and anaesthetist, a team with one vision - to make the patient experience the best it could possibly be!