Langley Memorial Hospital has, like all institutions, a culture and a sense of itself that shapes and is shaped by the people who pass through it, either as staff or patients. One part of Langley’s culture is a sense of getting the job done, even when faced with less than adequate resources and an aging infrastructure. So it is fitting, perhaps, that a common surgical condition which has been treated inadequately should find at Langley the commitment to turn this around and do the right thing, at the right time. Acute gallbladder inflammation, otherwise known as acute cholecystitis, has an interesting history of treatment, with the first operations dating to the late 19th century. In the later part of the 20th century prolonged hospitalization with antibiotic therapy became the norm. By the early part of the 21st century it became increasingly clear, through multiple scientific trials, that early surgery at time of admission was the best treatment. Early surgery is both better for the patient (less risk of complications, shortened hospital stay, earlier return back to work or normal life) and less expensive to the health care system — two facts that do not often go together. The surgeons and staff at Langley committed to doing the right thing by promoting a culture of early surgery for this common and painful surgical condition The results of that effort are summarized in this publication, and continue on as another part of the culture of Langley Memorial.