Therapeutic gastrointestinal endoscopy is increasingly diverse and complex. The concept of non-technical skills (NTS) is familiar to most and directly linked to performance, quality and safety outcomes in healthcare. In the realm of advanced endoscopy, NTS are more relevant than ever. Highly effective advanced endoscopy teams require key attributes, including the principles of selection, acceptance, complication, reconnaissance, envelopment and documentation (SACRED)—the sacred ‘art’ of high-performance endoscopy. This is particularly the case when considering the coordination required to lead a team in performing an intricate practical procedure associated with a higher risk for adverse events. Knowledge from surgical subspecialties and the aviation industry applies to advanced endoscopy, and suggests there is merit in enhancing the skills of the whole team rather than investing in the endoscopist alone. Additionally, the advanced endoscopy service should not be defined by, or limited to, the procedure within the endoscopy theatre. Instead, it should be considered as an overarching process that embraces the entire patient journey, starting from the moment of referral and encompassing postprocedural care.

Much of the literature regarding the impact of NTS comes from the surgical sphere, where insufficient NTS have been shown to increase error and the risk of harm to patients. NTS in gastrointestinal endoscopy were not fully appreciated until the landmark 2004 National Confidential Enquiry into Patient Outcome and Death report highlighted their deficiencies as a contributory factor to 30-day mortality following therapeutic procedures.1 …