Endoscopy
endoscope decreased, not because staffing levels changed, but because technician time was used more efficiently. Over the course of a year, this is projected to release capacity within the service, potentially enabling higher throughput and easing pressure on the workforce.24 This illustrates an important principle for service improvement: meaningful efficiency gains are often achieved through better use of time and resources rather than through immediate cash savings. In high-volume areas such as endoscopy decontamination, even small reductions in task duration can deliver operational benefits when applied at scale. The findings also align with NHS productivity priorities set out in the Long Term Workforce Plan, which assumes annual productivity growth supported by process redesign and better use of technology.25-26
Discussion The findings of this observational study could have wider implications for NHS decontamination and endoscopy services. Supporting sustainability objectives: Water
conservation is an increasingly important element of NHS sustainability strategies. Endoscopy reprocessing represents a high-volume, repeatable activity where incremental improvements could deliver environmental benefits. This study demonstrates that meaningful water savings can be achieved without capital investment or infrastructure changes. Instead, improvements were realised through the implementation of a new detergent and the removal of the final rinse step. This approach is consistent with the ‘no-regrets’ measures described in NHS Green Plans and net-zero programmes, where low-cost changes to consumables, protocols and staff behaviours are encouraged to deliver early environmental and cost savings alongside larger estates and infrastructure projects.5,27,28 Environmental impact assessments in endoscopy consistently highlight that reprocessing stages are resource-intensive, particularly in terms of water, energy and chemical disinfectants, and therefore represent an important focus for efforts to improve the environmental performance of reusable endoscopes.23,29 Addressing workforce pressures: Workforce sustainability is a growing concern across healthcare, particularly in specialist support services such as decontamination. Reducing unnecessary workload and improving process efficiency could help alleviate pressure on staff and improve service resilience. The reduction in manual cleaning time observed in this observational study translated directly into 17% additional capacity created
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with existing resources, reducing strain during peak periods.24
Over time, such efficiencies may
also contribute to improved staff retention and reduced fatigue. By simplifying workflow and reducing physical handling time, the revised process may also help mitigate some of the ergonomic risks associated with repetitive manual cleaning tasks, given that repetitive, forceful and prolonged endoscopy-related activities are known risk factors for musculoskeletal injury.19 Transferability to other settings: While this
evaluation was conducted within a single NHS Trust, the findings provide useful insight into how changes to manual cleaning processes may influence efficiency and resource use in a high-throughput endoscopy setting. The results indicate measurable improvements in water usage and operational efficiency, supporting wider NHS sustainability objectives. However, the authors acknowledge that the study was limited to one site and was not designed for statistical comparison. As such, the findings should be interpreted as indicative rather than definitive. The structured approach adopted nevertheless offers a practical framework for assessing operational impact in similar services. The evaluation approach used here, combining time-and-motion analysis, water-use estimation and staff feedback, provides a practical framework that other endoscopy decontamination units can adapt within local quality improvement programmes. Further work, including multi-site evaluations and analysis of task-level data, would be valuable in validating these findings and determining the extent to which similar benefits could be realised across other endoscopy units. Future opportunities include integrating smart water metering, real-time monitoring of washer– disinfectors and digital dashboards for technician workload, to support ongoing optimisation of resource use and standardisation of sustainable decontamination practice.
Conclusion This observational study demonstrated that targeted changes to manual endoscope cleaning processes can deliver measurable improvements in efficiency, sustainability and workforce utilisation. By removing the final rinse step after manual cleaning, Blackpool Teaching Hospitals NHS Foundation Trust achieved:24 l 15% decrease in average manual cleaning time l 25 litres of water saved per flexible endoscope l 725,000 litres projected annual water savings l 17% additional capacity created with existing resources
l 963 technician hours saved annually l Greater flexibility in workforce utilisation,
reducing the immediate need for additional staffing
l Additional operational capacity to support planned increases in endoscope throughput
As endoscopy services continue to expand and sustainability pressures intensify, such practical, evidence-based improvements will play an increasingly important role in ensuring services remain efficient, resilient and environmentally responsible. The findings illustrate how small protocol-level changes can contribute to national net-zero ambitions and support the design and operation of greener clinical services. For decontamination leads, estates teams
and clinical managers, this work highlights the combined sustainability and workforce impact of operational improvements. Small changes, when applied at scale, can deliver substantial benefits for both services and patients. Embedding routine measurement of time, water and energy use within reprocessing pathways will be essential to identify further opportunities and to demonstrate ongoing progress against NHS sustainability and productivity goals.
CSJ References for this article are available upon request. About the authors
Joshua Hicks is the Health Economics and Market Access Manager for the UK and Ireland at Olympus Corporation. With experience in health technology
assessment, reimbursement strategy, and real- world evidence generation, he supports the development of value propositions that enable the adoption of innovative medtech solutions across the NHS.
Mutsa Mutowo is the Health Economics and Market Access Lead for Australia and New Zealand at Olympus Corporation. She holds a PhD in Public Health
from Monash University and an MPH (Health Economics) from the University of Melbourne. Specialising in health economics, market access, and health technology assessment, she applies her expertise in reimbursement strategies, health economic modelling, and value communication to improve access to innovative technologies in clinical settings.
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