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Introduction The Joint Advisory Group (JAG) for Gastrointestinal Endoscopy (GIE) has demonstrated that the implementation of endoscopy quality metrics improves service delivery throughout the patient pathway. 1 Prior to introducing a national bowel screening programme in New Zealand (NZ), the Ministry of Health (MoH) sought to develop a quality programme to optimise the standard of colonoscopy services across NZ. Challenges include a shortage of facilities and a workforce very dependent on overseas specialists, as well as significant socio-economic and cultural diversity and inequity in healthcare provision.Methods The Global Rating Scale (GRS), led by JAG was identified as a suitable quality improvement framework to adapt for the NZ health system, and the NZGRS was developed in partnership with JAG. The National Endoscopy Quality Improvement Programme (NEQIP) was established with a clinical leadership team to provide support. NZGRS standards and measures were formulated within 4 domains: Clinical Quality, Quality of Patient Experience, Workforce and Endoscopist Training. A census was piloted in 4 units, then implemented in all publicly funded endoscopy units (now 32). A revision of the standards was undertaken in 2019.All units participate in a biannual self-assessed census, with detailed results and recommendations provided to individual units and the MoH.Results National census completion has consistently been 100%. A minimum of level B in all 19 standards is the programme aim. Since November 2019, the national percentage of all standards at level A and B has improved from 31 to 70%.Substantial improvement has been achieved by units in all quality standards, notably Safety (from 19 to 91% of units achieving A or B scores), Comfort (29 to 91%) and Quality (26 to 91%). The Consent process standard improved from 29 to 91%, Aftercare from 71 to 100%, Results from 42% to 91% and Patient involvement from 26 to 72%. Units who have not yet reached level B have made incremental improvements from level D to C. In the Training Domain, some improvements have been seen with the Environment, Training Opportunity and Resources standards.Conclusion A coordinated national quality improvement programme with a high level of unit engagement has improved the delivery of GIE services in NZ, enhancing patient experience and outcomes. Effective international partnership working with JAG has been a key contributing factor to the achievements made. Limited resources and NZ specific barriers have impacted on facilities and training and addressing these issues is likely to result in further improvement.Reference Siau K, Green J, Hawkes N, et al. Impact of the joint advisory group on gastrointestinal endoscopy (JAG) on endoscopy services in the UK & beyond. Frontline Gastroenterology 2019:10:93–106.