Clinical Advisory
Clinical audit vs quality improvement
In short: Clinical audit measures practice against a defined standard and closes the gap; quality improvement (QI) iteratively tests changes to improve a process. Audit asks "are we meeting the standard?"; QI asks "how do we make this better?" — and they work well together.
Clinical audit
Audit sets an explicit standard (often from a guideline), measures current practice against it, identifies gaps, implements change, then re-audits to confirm improvement. It is ideal where the "right" standard is already defined.
Quality improvement
QI uses small, iterative tests of change — commonly Plan-Do-Study-Act (PDSA) cycles — to improve a process where the best approach is not fixed. It emphasises measurement over time and learning from each cycle.
Using them together
An audit can reveal a gap; QI can be the method you use to close it. Strong governance portfolios often show both, with clear measures and demonstrable improvement.
Meds Global Health provides audit packs, QI storyboards and implementation support. See Audit & Quality Improvement.
The QI method
How a PDSA cycle works in practice
Quality improvement is built on small, fast tests of change rather than one big roll-out. The Plan-Do-Study-Act (PDSA) cycle is the engine:
- PlanDecide on a small change, predict its effect, and define how you will measure it.
- DoRun the change on a small scale and record what actually happens, including the unexpected.
- StudyCompare the result with your prediction and learn from the gap.
- ActAdopt, adapt or abandon the change, then start the next cycle with what you learned.
The discipline is the measure over time — typically tracked on a run chart — so improvement is demonstrable rather than asserted. Several small cycles de-risk change: a misstep affects a handful of cases, not a whole service, and each cycle sharpens the next. This is what distinguishes genuine QI from a one-off change that was never tested.
Avoid the confusion
Common pitfalls — and the research boundary
The most frequent governance error is misclassifying a project. Audit and QI evaluate or improve existing care against known standards and generally do not need research ethics approval. Research sets out to create new, generalisable knowledge and does require formal ethics and governance. A project that randomises patients, tests an unproven intervention or aims to publish generalisable findings has usually crossed into research — checking this early avoids a serious problem later.
Other recurring pitfalls include auditing without a clear, measurable standard; running a single PDSA cycle and calling it improvement; and never closing the loop with a re-audit. A robust governance portfolio shows the full cycle — a standard, a measured gap, a tested change, and re-measurement proving it held. Linking audit findings to a QI method to close the gap is exactly the pattern NHS appraisers and interviewers look for; it also strengthens applications via portfolio and CV review, and connects to the wider IMG route to the NHS.
Answers
Frequently asked questions
What is the difference between audit and QI?
Clinical audit compares current practice against an explicit standard and identifies gaps to close (a cycle of measure → change → re-measure). Quality improvement (QI) uses iterative tests of change — often Plan-Do-Study-Act cycles — to improve a process over time. Audit asks "are we meeting the standard?"; QI asks "how do we make this better?".
Which should I use?
Use audit when there is a clear standard to measure against (e.g. a guideline); use QI when you want to redesign or improve a process where the best approach is not fixed. They often complement each other.
Do you support both?
Yes — audit packs, QI storyboards and implementation support. See Audit & Quality Improvement.
What is a PDSA cycle?
Plan-Do-Study-Act is the core QI method: plan a small change and predict its effect, do it on a small scale, study what actually happened against the prediction, then act — adopt, adapt or abandon — before the next cycle. Running several small cycles is safer and more informative than one large untested change.
Are audit and QI the same as research?
No. Audit and QI evaluate or improve existing care against known standards and usually do not require ethics approval, whereas research generates new generalisable knowledge and does. Misclassifying a project — especially one that should have research governance — is a common pitfall.
How do these strengthen a portfolio?
A completed audit cycle that shows re-measured improvement, or a QI project with a clear measure over time, demonstrates that you can change practice — valued in appraisal, applications and interviews. See Interview, Portfolio & CV Review.
Running an audit or QI project?
We provide the templates and implementation support.