Quality Improvement (QI) is increasingly prominent in NHS interviews and medical training portfolios. While closely related to clinical audit, QI has a distinct methodology and philosophy. Understanding the difference — and being able to discuss QI confidently — is a significant advantage.
What Is Quality Improvement?
QI is a systematic approach to making changes that lead to better patient outcomes, better system performance, and better professional development. Unlike clinical audit, which measures practice against a pre-existing standard, QI projects often address problems where no specific standard exists or where the goal is to design a new process or system. The NHS Long Term Plan (2019) and the NHS Patient Safety Strategy (2019) both emphasise QI as a core competency for all healthcare professionals.
The PDSA Cycle (Plan-Do-Study-Act)
The Plan-Do-Study-Act cycle, developed by the Institute for Healthcare Improvement (IHI), is the most widely used QI methodology in the NHS. It involves small, iterative tests of change:
- Plan: Identify the problem, review the evidence, and plan a specific change to test. State your aim (what are you trying to achieve?), your measure (how will you know if the change is an improvement?), and your change idea (what change will you test?). A useful framework for setting aims is the SMART criteria: Specific, Measurable, Achievable, Relevant, and Time-bound.
- Do: Implement the change on a small scale. This might mean testing the change with a single ward, a single shift, or a small number of patients before rolling it out more widely.
- Study: Collect data and analyse the results. Did the change lead to improvement? Were there unintended consequences? What did you learn?
- Act: Based on what you learned, decide whether to adopt the change (if it worked), adapt it (if it partly worked), or abandon it (if it did not work). Then plan the next PDSA cycle with refinements. Multiple PDSA cycles are expected — QI is iterative, not a one-off exercise.
QI Tools You Should Know
The panel may ask about QI tools, particularly if you are applying for a post with a QI component. The key tools to be aware of are: Driver diagrams (visual tools that map the relationship between a project aim, primary drivers, secondary drivers, and specific change ideas), Process mapping (flowcharts that show the steps in a clinical process, helping to identify bottlenecks and waste), Run charts (simple time-series graphs that show whether a change has led to a measurable improvement over time — a key visual tool for demonstrating QI impact), and Fishbone diagrams (also called Ishikawa diagrams — used to identify root causes of a problem by categorising potential causes into groups such as people, process, equipment, environment, and materials).
Audit vs QI — The Key Differences
This is a frequently asked interview question. Clinical audit measures current practice against an existing standard and identifies whether the standard is being met. QI aims to improve a process or outcome, often where no specific standard exists, using iterative testing of changes (PDSA cycles). Audit answers the question “Are we doing it right?” QI answers the question “How can we do it better?” In practice, the two often overlap: an audit may identify a gap that triggers a QI project, and a QI project may use audit data to measure its impact.
How to Present QI Experience in an Interview
Structure: (1) What problem did you identify and why was it important? (2) What was your aim? (3) What change did you test? (4) How many PDSA cycles did you complete? (5) What were the results? (6) Was the change sustained? Even informal examples count — if you noticed that handovers on your ward were disorganised and you introduced a structured handover sheet that the team adopted, that is a QI project, even if you did not formally call it one.