The development and implementation of an integrated Quality Improvement Program (QIP) for the Department of Surgery at The Hospital for Sick Children was approached as a problem-solving process by which departmental managers could bring about change so that actual results would align more closely with desired outcomes. A planned and systematic process was developed, through which managers are able to reach decisions about when and where to make useful changes that result in improved quality of care and services provided. Three useful techniques were employed: team-building, continuing education and quality circles.