Much has been written about the challenges of surgeon engagement in quality and safety improvement work. In Taitz and colleagues’ 2011 seminal work, one interviewee alluded to the difficulties in engaging surgeons in quality improvement by opining that ‘you can’t do quality between surgical cases and tea time’.1 There are several factors that may explain why surgeons have historically been difficult to engage in quality improvement work, including a lack of improvement culture, limited training and skills, inconvenience of timing of most daytime improvement work, lack of remuneration and inadequate feedback on surgeon performance on various quality metrics.2 Understanding and targeting these factors may improve the culture of quality improvement among surgeons.