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Clinical audit vs quality improvement vs research: the differences

By the Health Job Scout team · 5 min read · Fact-checked 1 November 2026

Clinical audit, quality improvement (QI) and research are three different kinds of project, and doctors often mix them up. Each one asks a different question, and which one you choose changes how much time it takes and who has to approve it. This post sets out the difference, using HQIP, the Health Research Authority and our own advice, which we label as such.

The short answer

• Clinical audit asks: are we doing what we should be doing, and how well?
• Quality improvement asks: will this change make care better?
• Research asks: what is the right thing to do? It aims to produce new knowledge.

What clinical audit is

HQIP describes clinical audit as a quality improvement cycle. You measure care against agreed standards, take action to bring practice in line with them, and then measure again to see whether things improved. HQIP says audit checks whether care is meeting the standard, and how well. Our post on how a clinical audit works goes through the steps.

What quality improvement (QI) is

HQIP notes that quality improvement has no single agreed definition. Broadly it means using methods and tools in a structured way to keep improving care and patient outcomes, by designing a change, testing it and measuring the effect.

One common method is the plan, do, study, act (PDSA) cycle. HQIP explains that you plan a change, test it on a small scale in the live setting, evaluate the result and act on it. After several cycles, you can roll the change out more widely. Audit sits inside this wider family: HQIP lists clinical audit as one of the tools in its quality improvement guide.

What research is

HQIP says research is about new knowledge, such as which treatments work best. The Health Research Authority has a tool called Is my study research? It asks a short series of yes or no questions and tells you whether your project counts as research under the UK Policy Framework for Health and Social Care Research. If your project could be research, use the tool instead of deciding yourself.

Does clinical audit need ethics approval?

HQIP says that, unlike research, clinical audit does not need approval from a research ethics committee, and it attributes that to the National Research Ethics Service. That does not mean you can start without telling anyone. Our advice is to ask your trust's audit or clinical governance team how it registers audit and quality improvement projects before you collect any data.

Which should you do first: audit, QI or research?

This section is our opinion, not guidance from HQIP or the Health Research Authority.

• Clinical audit has a clear shape, so it is often a sensible first project. You need a standard to measure against, access to the data, and a supervisor who agrees the plan.
• Quality improvement needs a team that can make a change and keep measuring after it, which can be hard if you are on a short rotation.
• Research often takes the longest and brings extra approvals, so most doctors with a few months to spare would not start here.

If you are not in a post yet, a short attachment is one way to get a supervisor and a team, and our guide on finding and asking for a clinical attachment covers it. Whichever you choose, say honestly in your application what you did yourself and what the team did. Our supporting statement guide shows how to write evidence against each criterion, and the post on applying without NHS experience covers the wider question.

Where the Audit toolkit fits

Audit, quality improvement and research: the short version

Audit checks care against a standard, quality improvement tests a change, and research produces new knowledge. If you are not sure which one your project is, ask your supervisor, and use the Health Research Authority tool if it could be research.

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