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Culture of continuous improvement
  1. John F Stebbing
  1. Department of GI Surgery, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
  1. Correspondence to John F Stebbing, Royal Surrey NHS Foundation Trust, Guildford, GU2 7XX, UK; j.stebbing{at}nhs.net

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Patients requiring lower GI endoscopy should rightly expect a procedure which is safe, comfortable and effective. Effectiveness is achieved by complete intubation, careful mucosal inspection, recognition and accurate characterisation of any abnormality together with competent delivery of appropriate therapy. These statements seem self-evident today in an era of established quality assurance (QA) of both service and training provision, but it was not so long ago that the landscape looked very different.

As the evidence for population-based screening for colorectal cancer accumulated through the 1990s, it was recognised that the capacity available and quality of delivery of colonoscopy were too poor and variable for this evidence to be translated into an effective programme, summarised in a joint position statement in 2000.1 Just 19 years ago, 2004 was a notable year. Publication of a prospective audit of UK colonoscopy by Bowles et al provided challenging evidence of incomplete examinations with caecal intubation rates of <80% and evidence of significant levels of discomfort and morbidity associated with the procedure.2 The Joint Advisory Group …

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Footnotes

  • Contributors I am very pleased to be asked to provide an invited commentary on these two papers and hope that the content of my submission sets the importance of these contributions in the context of quality improvement in endoscopic practice over the last 20 years.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The author served as Chair of the Joint Advisory Group on GI Endoscopy from February 2011 to December 2016.

  • Provenance and peer review Commissioned; internally peer reviewed.

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