Evaluating quality in endoscopy.

Despite an increasing number of publications and suggested quality measures, evaluating quality in endoscopy remains a challenge. Most quality measures are process measures and lack evidence for an association with clinically important outcomes. Furthermore, most measure focus on procedural aspects. Patients' expectations, cultural values, and work setting also affect quality, but are less often considered. The aim of this article is to broaden the view on quality assessment. Here, quality is viewed from four perspectives: an individual patient perspective, which considers expectations and personal values; a cultural perspective, which encompasses cultural values and norms; an individual care perspective, which includes how an individual patient is being treated; and a societal perspective, which sets the stage for provided care. The article concludes with a proposal to consider bundled composite measures as a path to a simple yet comprehensive approach to assessing and measuring quality in endoscopy.