Quality Improvement, Research and Audit

Is your project research, clinical audit or quality improvement? 

It can be difficult to distinguish between research, clinical audit and quality improvement projects.

To support you we have developed some resources and information which will help you to distinguish the difference. 

Click on the links below to read more.


According to the Health Research Authority (HRA) ‘research’ in the NHS is defined as:

“the attempt to derive generalisable new knowledge including studies that aim to generate hypotheses as well as studies that aim to test them”.

Research is designed and conducted to generate new knowledge and should follow the systems for approval of NHS Research.

You can find more useful information about this at this Health Research Authority webpage http://www.hra-decisiontools.org.uk/research/

Clinical Audit

According to NHS England, clinical audit is a way to find out if healthcare is being provided in line with standards and lets care providers and patients know where their service is doing well, and where there could be improvements.

Audit is designed to answer the question "Does this service reach a predetermined standard?"

At CNWL we participate in Clinical Audit in the following ways:

National and Trust wide Clinical Audits and Reviews.

Every year the National Quality Improvement Partnership (HQIP) led by the Academy of Royal Colleges, the Royal College of Nursing and National Voices publishes a list of national audits and Clinical Outcome Review programmes (National Confidential Enquiries). This includes the POMH UK audits. CNWL clinicians pride themselves in participating in these audits and reviews pertinent to the services we provide and this is published every year in our Quality Account.

Division Focussed Audits

These clinical audits are agreed in Divisions and are used as a proxy measures for performance standards when this information is not readily available via our electronic systems.

Local Audits

These are usually audits of team and individual based interest focussed on care delivery issues

Quality Improvement

The term ‘quality improvement’ refers to the systematic use of methods and tools to try to continuously improve quality of care and outcomes for patients.

There are a range of different methods and tools, such as Lean, Six Sigma and the Institute for Healthcare Improvement’s Model for Improvement.

There is no clear evidence that one approach is superior to others. Rather, it is the process for having a systematic approach to quality improvement and applying this consistently that is important (Ross and Naylor 2017, The Kings Fund).

The table below gives a summary:

Activity Research Quality Improvement Audit
Formal Definition The attempt  to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods Systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare in particular settings A QI process that seeks to improve care and outcomes through systematic review of care against explicit criteria and the implementation of change
Nature of the Activity Generating hypotheses and verifying scientifically a predicted, but not necessarily proven, relationship between or among variables such as clinical processes and outcomes Using quantitative or qualitative data to identify problems in the delivery of care and their causes and act to achieve improvement in an aspect of care Comparing actual patients care to the type of care that represents best practice and act on the findings to achieve improvement in delivering best practice
Ethics Involvement Requires Research Ethics Committee review  Should have oversight of projects to identify and address any ethical issues Should have oversight of projects to identify and address any ethical issues    
Source: Healthcare Quality Improvement Partnership (HQIP)


What’s the Difference Between Research and Quality Improvement?


Useful Contacts for CNWL staff    


If you are considering starting a Research Project please visit the Trust’s Research and Development page on Trustnet

Alternatively contact:

Clinical Audit

To find out more about the National Audit Programme and Clinical Outcome Reviews CNWL are participating in contact:

David Jones (Clinical Effectiveness Manager, Quality Directorate)
Email :  david.jones19@nhs.net 

If you are considering starting a local Clinical Audit Project please contact:
Emma Johnson (Head of Quality Governance, Diggory Division)

Tola Phillips (Head of Governance, Goodall Division)

Lorianne Martin (Head of Governance, Jameson Division) 

Quality Improvement

If you are considering starting a QI Project please contact us.


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