The Implementation of a Standardized Workflow Improves Job Satisfaction in the Endoscopy Centre

By CHAN Chui Fung, Joe, NO II, MSc.(HSM), MSc.(Gastroenterology), and BPhil(Health Care), Endoscopy Centre


In 2017, Endoscopy Centre conducted a training satisfaction survey for new nurses. Over 65% of new staff reported feeling stress as they take up the role of circulating nurse and assistant nurse.

All mentors are experience endoscopy nurse with various background, different training experience as well as mentoring experience. These difference leads to variation in mentoring style which may cause role confusion for new nurses. If this situation remains unresolved, it could lead to frustration for new nurses and eventually lead to burnout. Since all staff are a valuable assets to our hospital, it is imperative to find an effective way to retain our staff by improving job satisfaction through addressing the standardized workflow.

Purpose and Problem Statement

The purpose of this project is to increase job satisfaction and reduce stress by a standardized workflow corresponding to our hospital’s core values (Teaching, Teamwork & Trust). The PICO question is that does the implementation of a standardized workflow by Pit-Stop Model improves job satisfaction in the Endoscopy Centre?

Implementation Plan

A 5-point Likert scale questionnaire was distributed to Endoscopy nurses (n=25) in April and October 2018 to evaluate job satisfaction & stress level by using a modified work quality index and a modified job-related well-being scale respectively.

The principle of Pit-Stop Model was adopted in this study which were Task Sequence, Task Allocation and Discipline & Composure. Education mentor group was established and meeting was conducted with interactive discussion to make a consensus on a standardized workflow. Educational Lectures and video demonstrations were launched to ensure standardization among all level of staff to eliminate role confusion.


The sample size was 25 and response rate was 100%. Data were analyzed by using descriptive method and were divided into 2 groups, i.e. new nurses (less than 2-years experienced in Endoscopy) and experience nurses (over 2-years experienced in Endoscopy). The overall work satisfaction rate is around 67% in which 100% of new nurses have higher satisfaction rate than before the intervention. The difference between new and experience nurses were not obvious which decreased from 11% to 2%. It indicated that the implementation of standardized workflow was effective to increase job satisfaction, especially for new nurses.

For stress level, both group reported significant drop on it. 75% of endoscopy nurses have lower stress level than before. It is a great improvement. Standardized workflow is successful to reduce role conflict and ease the stress related to it.

Recommendations and Next Steps

Change is always difficult. Therefore, communication is essential for success. We should engage all level of staff to communicate throughout the practice change process in order to achieve teaching, trust and teamwork spirit and hence to influence the culture norm in the long run. Therefore, education mentor group meeting and educational lectures are recommended to conduct regularly. A Standardized Workflow is an opportunity to re-examine workflows and redesigning processes to maximize the benefits of the optimal patient care. It presents an opportunity to consolidate and change process in the latest practice so as to share with other team members to increase efficiencies. Therefore, we should take this as opportunity for better clinical service evolution rather than the threat of our clinical practice. Annually review of workflow should be consider in the current practice.

Over time, people may return to their own habit. Since it is a short term study, regular audit should be conducted to ensure the compliance of the standardized workflow and sustainability. Mentoring training programs which focus on promoting the characteristics of effective mentors and facilitating 3T culture and mentoring relationship should be introduced to all mentors in order to diminish variation in mentoring style.