Quality Assurance, Audit, and Service Improvement
Definitions
Quality assurance is the planned activity that confirms standards are met. Clinical audit measures practice against an agreed standard and closes the loop by changing practice and re-auditing. Quality improvement uses iterative tests of change (PDSA) to improve processes. Research generates new generalisable knowledge and requires ethical approval. Confusing these is a common exam trap.
Standards and measurement
Choose a standard with a source (guideline, national specification, local policy), define the indicator precisely, and decide the sample and period in advance. Measure both process (was it done) and outcome (did it help), and include patient experience. Small samples give unstable estimates; use run charts or statistical process control to distinguish signal from variation.
Improvement
Engage the people who do the work and those who receive it. Test changes on a small scale, study the result, and adapt before spreading. Report through governance structures and re-audit to confirm sustainment.
Traps
Calling an audit 'research' or vice versa; closing the loop without re-measurement; measuring what is easy rather than what matters; and attributing improvement to your change when a seasonal or secular trend explains it.
Worked example
Standard: 90% of MDT decisions documented with a named owner. Sample 30 consecutive meetings. Result: 62%. Intervention: a one-line action log template. Re-audit after three months: 88%. A second PDSA cycle targets the remainder.
Rule of thumb
No audit without a standard; no improvement without re-measurement; no conclusion without considering alternative explanations.