Introduction The Darzi Report states seven steps are required to maintain and achieve high quality standards in the NHS. This includes measurement of clinical performance as a function of quality and cost-effectiveness. Reproducible performance models may be helpful in developing quality improvement processes. Methods Analysis of all endoscopy procedures performed at Derriford Hospital between January 2007 ? December 2008. Points allocation:two per colonoscopy and one per gastroscopy. Local health economic analysis revealed that ?8 points must be performed to meet costs. Following analysis individualised feedback was given to each endoscopist on their performance and areas for improvement. The audit cycle was completed over the next year. Results In total, 4069 colonoscopies were performed (cf. 3884 in 2007). There was improvement in both crude Caecal Intubation Rate (CIR) from 89.6% (2007) to 91.1% (2008), and Points/List from 8.0 (2007) to 8.4 (2008). ?Clinical Performance? was compared by plotting a capability index of individual crude CIRs against Points/List. The improvement in Points/List equates to an increase in unit profitability of greater than 300,000 pounds. There was reduction in training opportunities possibly due to introduction of the National Bowel Screening Programme. Conclusion Introduction of auditable performance measurements has dramatically improved both quality and productivity of our endoscopy unit. Take-home message: A method of improving the quality and cost effectiveness of an endoscopy unit.

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