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Objective: To promote a friendly and service oriented environment within a large hospital for women and children, staff and service feedbacks were obtained. These revealed that hospital staff did not smile readily when they encountered each other in thehospital. The objective is to improve smile levels amongst health care staff in a hospital using a standardised smile score scale. Methods: A baseline survey on the status of smile of hospital was performed using a standardised Smile Score Scale (with scale from -1 to 10). Smile levels were scored when assessors encountered staff along corridors and lifts. The scores were standardised according to level of familiarity and assessors' own smile score. Two further surveys were performed after measures to improve smile were implemented Results: With an assessor smile level of 2 for 165 staff subjects (first survey), the overall standardised smile level was 1.51. Measures were taken by a team to enhance awareness of the importance of smile and to remind staff to smile. Despite these measures, a second survey of 206 staff subjects revealed a smile score level of only 1.43. Another set of measures was implemented which include emphasis on leadership encouragement, spontaneous initiation of smile, and instant positive reinforcements for smile. A third survey of 245 staff subjects revealed an improvement in overall smile score level to 2.00. There was an improvement of 32.5% over the baseline smile score of 1.51. In tandem, the proportion of staff with Smile Score Level 2 and above, decreased from 61.8% in the first survey to 50.0% in the second survey (p Keywords: Smile Levels/Smile Score Scale/Initiation of Smile/Hospital Process Improvement Project/Health Care Staff/Service Quality/Women's and Children's Hospital, Introduction Service quality and clinical quality are important in all hospitals and are often interlinked. KK Women's and Children's Hospital (KKH), formerly world's largest maternity hospital, is an 800-bedder-hospital providing [...]