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Background Compliance with enhanced recovery programmes (ERPs) in oesophago-gastric (OG) surgery is challenging due to high rates of complications. Higher compliance is associated with better outcomes; however compliance is difficult to assess due to variable reporting and lack of standardisation of descriptors within an ERP. This study aims to understand variability in ERPs across two OG cancer centres and analyse impact of cross-site engagement and collaborative quality improvement (QI) on ERP compliance. Methods The collaborative QI project consisted of workshops and meetings that involved presentations and assessment of variations across ERPs, with prospective recording of ERP compliance at each site and cross-site feedback of results. Compliance and outcomes for 2016 were compared with 2017 to assess impact of QI initiative. Results At site A, overall mobilisation improved from 25% to 28% (P  = 0.448) and oral intake from 19% to 56% (P  = 0.002). There were no improvements in NGT (65% to 54%) and drain removal (69% to 53%). At site B, mobilisation improved from 51% to 68% (P  = 0.097), NGT removal from 37% to 51% (P  = 0.196), and drain removal from 15% to 32% (P  = 0.412). There was no improvement in oral intake (47% to 34%). At site A, all complications reduced from 56% to 46% (P  = 0.401), pneumonia from 47% to 22% (P  = 0.024), and grade 3 complications from 22% to 15% (P  = 0.605). At site B, all complications reduced from 58% to 54% (P  = 0.697), pneumonia from 46% to 37% (P  = 0.353), and grade 3 complications from 23% to 20% (P  = 0.678). At site A, the median length of hospital stay reduced from 11 days to 9 days (P  = 0.024), with no improvement at site B (12 to 14 days). Conclusion Engagement between clinical teams across the two sites resulted in improvement in postoperative outcomes. Compliance with individual ERP elements was observed across a few domains. Challenges encountered in this project included a lack of standardised definitions of ERP descriptors, variability in measures and variations in the individual elements within each ERP. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]