Access to endoscopy is essential for achieving high rates of colorectal cancer screening. Last-minute cancellations and no-shows are relatively common for outpatient endoscopic procedures, yet filling these vacated appointment slots the same day is challenging. Unfilled spots result in decreased revenue, decreased productivity, and worsened access to endoscopy. Our lean performance improvement project aimed to decrease the no-show rate of ambulatory endoscopies at a large Veterans Affairs hospital endoscopy unit with a baseline no-show rate of 16% per day.