You may have an idea for a project, but we often hear the question “Is my project research, clinical audit or quality improvement? “

It can be difficult to distinguish between research, clinical audit and quality improvement projects, but each has a different way of progressing as a project and different reasons for undertaking them.

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

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, which often involves gaining ethical approval for the process of gathering data across a large set of subjects.

You can find more useful information about this at this Health Research Authority webpage.

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?" and involves collection of data as a ‘snapshot’ that can be analysed to understand whether the service is performing in the best way.

Audits can often highlight areas of lesser performance, which can be addressed by using Quality Improvement methodologies to bring service performance up to the desired standard.

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).

QI data is collected and plotted over time, looking for changes in the data such as shifts or trends that indicate that an improvement is being made.

The table below gives a summary:



Quality Improvement


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)