How does perception of the bowel cancer screening colonoscopy service differ between Screening and Non-Screening Colonoscopists and what are the differences in quality and productivity?

Introduction Quality assurance and performance management of colonoscopy in Wales appears to be more robust within the screening programme than the non-screening service. It is uncertain if these processes lead to improved quality or productivity and if the assessment process for potential screening colonoscopists deters colonoscopists from applying. Method A mixed methods study comprising of analysis of individual colonoscopists, and endoscopy units’ key performance indicator (KPI) data was conducted. KPI data from 6 of the 7 Welsh health boards was analysed and data used to develop interview guides for semi structured interviews. 10 Screening Colonoscopists, 10 Non-Screening Colonoscopists, 3 Specialist Screening Practitioners and 3 Endoscopy Unit Managers were interviewed to explore perceptions of quality and productivity of the screening and non- screening colonoscopy services and acceptability of assessment and accreditation processes. Results The study showed a statistically significant variation in polyp detection rate with Screening Colonoscopists achieving 62% and Non-Screening Colonoscopists a mean of 32% (p=.00). The rate of procedures undertaken without sedation was also statistically significant between the groups with Screening Colonoscopists performing more unsedated procedures (35% compared to 19% in Non-Screening Colonoscopists p=.005). All other KPI’s analysed revealed no significant difference. Qualitative data suggested a strong perception of increased quality and productivity within the screening programme and although some interviewees considered the assessment process to be a deterrent to potential Screening Colonoscopists, it was considered necessary. Conclusions The screening colonoscopy service in Wales is perceived to be associated with higher quality and increased productivity compared to the non-screening colonoscopy service and there is some quantitative data to support this. The Screening Colonoscopist assessment process is considered necessary, although some improvements have been suggested including shorter timeframes and greater mentorship