A passion for hockey and sports eventually led Dr. Joe Costa to a career in orthopaedic surgery. Orthopaedic surgeries always require diagnostic images, such as x-rays, but due to variation in ordering pathways, up to 30% of x-rays ordered are not what the surgeon is looking for. This leads to repeated x-rays which are expensive for the healthcare system, and frustrating for patients. In this episode Dr. Costa discusses how he and his team aimed to improve the proportion of appropriate, complete, and necessary diagnostic images for MSK (musculoskeletal) problems from 70 – 90%. He also shares his ‘earth-shattering’ realization that Quality Improvement science and methodology are instrumental for creating successful change, and reflects on the privilege of working with Northern patients, and how practicing in Northern BC allowed him to achieve the dream of a backyard hockey rink.