Background: Quality and safety are recognized as essential components of providing excellent care to patients.Not surprisingly these concepts have extended to endoscopy units.Much of the work to date has focused on procedural aspects of endoscopy.As a result, a robust framework for creating a safety-oriented culture as well as a scalable approach to identifying and solving quality and safety issues has not been well described.Methods:The Endoscopy CUSP team consists of a multi-disciplinary group that represents all the aspects of the endoscopy unit.At our institution this includes: all frontline staff including fellows, gastroenterologists, anesthesiologists, nurses, CRNAs, endoscopy technicians and customer service representatives as well as a physician champion, nursing administrator, and hospital executive.This group meets monthly to promote the CUSP framework by: 1) Training staff in the science of safety -formal education on safe design principles and teamwork, 2) Engaging staff in identifying defects -anonymously and formally survey staff for harms, 3) Partnering with a hospital executive in reviewing defects -provides mechanism for accountability and support, 4) Learning from defects -achieved through discussion and analysis using designated tools, and 5) Implementing improvement -represents action item to prevent future harm from occurring.This framework is iterative and is used for technical and non-technical issues.Results: Technical example: Preventing injury when changing an inverted CO2 tank used in cryotherapy.Defect was identified from event reporting system and discussed at CUSP meeting.Subgroup was formed to identify root causes including: poor strap design; insufficient warning label; manual unavailability; insufficient training from vendor.Solutions to these issues included: discussion with vendor to provide nurse training and suggestions on tank reconfiguration; clear warning labels; attached instruction manual; requirement for annual nursing skills competency assessment.Non-technical example: Establishing a clear and concise observer policy after recognizing an increase in the number of visitors to endoscopy, including vendors, research staff, visiting physicians, trainees, and students.Improving how patient privacy might be improved was discussed at the CUSP meeting.Subsequently, a formal visitor workflow was created including construction of visitor guidebook describing basic rules, visitor identification badge, and visitor confidentiality form attesting to privacy.Conclusion: An endoscopy CUSP team provides a model for creating a safety-oriented culture with a concrete framework for identifying and solving both technical and non-technical quality and safety issues.