Performance measure	We recommend endoscopy services be organized to acquire the necessary resources to deliver the service and to maximize utilization of these resources while maintaining high patient satisfaction, quality, and safety
Domain	Leadership and organization
Category	Structure and process
Rationale	An endoscopy service should first of all determine the demand it expects and what level of service provision it is required to deliver, as indicated by European and national regulation and guidance; it can then define the resources it needs – resources in this context include human as well as physical resources (see Domain 8 on staffing) Many nations will have referral guidelines but most will not have target intervention rates per head of population for common endoscopic procedures on which to base demand; however, it should be possible to estimate future demand of a service based on past activity (both actual and trends), size of backlog, and length of waiting lists, while new screening programmes will usually have accurate predictions of the extra demand on the service, making it possible for endoscopy services to plan for this There is intense pressure on endoscopic capacity in most countries and resources are constrained everywhere, so it is important to maximize use of resources (many services will be under intense pressure to do more for less, which could put patients at risk and affect quality and patient experience) This recommendation recognizes the tension and that achieving it will expose resource constraints that will impact on patient care
Standards	Minimum standard: an annual operational plan to meet the demands on the service that includes the necessary facilities, kit, information technology, safety equipment, workforce, and endoscopy list capacity Target standard: an annual assessment of the effectiveness of the plan; a medium- to long-term plan for future investment based on expected changes in demand
Consensus agreement	96.3%
PICO	Not applicable
Concordance with other guidelines	ASGE Not assessed	Canada Not assessed	EU Not assessed	GRS/JAG accreditation Yes
Evidence grading	Not applicable