Performance measure	We recommend key performance indicators are fed back to and discussed with endoscopists on a regular basis, and that corrective action for improvement, when indicated, with objectives are agreed with the individuals
Domain	Quality
Category	Process
Rationale	Systematic reviews indicate that when healthcare professionals are given data on their performance they will, in most circumstances, improve; there is evidence that this is the case in endoscopy
	Improvement in response to feedback is, however, highly variable because some may not consider it necessary to improve and others may not know how to get better; not all endoscopists will automatically get better when presented with performance data, so a discussion and plan, with agreed objectives, are necessary if all endoscopists are to improve It is expected that the endoscopist member of the leadership team will conduct this discussion; objectives may include further training that may have to be sourced elsewhere The frequency of feedback and discussion depends on the metrics for the procedure and the sample size required to know whether performance is below acceptable levels, but it is recommended that feedback occurs at least annually, more frequently if concerns have been raised about performance by patients, staff, or other endoscopists An open discussion of performance (all endoscopists knowing each other’s data) is to be recommended to foster an open and quality-focused culture; however, it is important that within the discussion of improving performance it is made clear what factors about the service (particularly the team) can be improved and what factors the individual is responsible for
Standards	Minimum standard: procedural performance data is fed back to individual endoscopists at least annually and there is guidance on what to do if recommended performance levels are not achieved and/or maintained Target standard: objectives are agreed with individuals to improve performance and all endoscopists are made aware of each other’s performance data
Consensus agreement	96.3%
PICO	Population: Any healthcare organization/unit/department, or any healthcare provider Intervention: Audit and feedback programmes Control: No audit and feedback programmes Outcome: Continued improvements in technique, quality, and safety of services/care provided
Concordance with other guidelines	ASGE Yes	Canada Yes	EU Yes	GRS/JAG accreditation Yes
Evidence grading	The overall quality of evidence was judged as low for inconsistency and indirectness