This article identifies and reviews key elements of quality improvement programs for an endoscopy unit. The new paradigm of quality improvement seeks to improve all performance, and does not simply focus on the low outliers as in the traditional "quality assurance" program. The organization and key elements are emphasized, including selection of key indicators and methodologies for the development of standards of practice and benchmarks. Examples of quality improvement initiatives are discussed, demonstrating their value in improved patient care and the process or function of an endoscopy unit.