Differentiating between research, audit and quality improvement: governance implications

In the context of changes in the priority given to ensuring that health care is evidence‐based, and that service quality should be maximised, there is a new emphasis on quality improvement programmes in the UK National Health Service (NHS). It is not clear how far these programmes can be categorised using the paradigms of research and audit. Making a distinction between what constitutes audit, quality improvement and research is important in the context of enhanced clinical and research governance requirements and in an environment of both sensitivity in relation to the ethics of research and concern about the efficacy of ethics committees. This study aims to address this issue.

This article reviews the literature on how quality improvement differs from audit and research. It considers different ways of considering ethics in research and questions how far one can rely on professional judgement as an alternative to formal ethics committee procedures. The factors that characterise different sorts of activity are reworked to enable a template to be devised. The template, presented in the form of a flow‐chart, enables health care workers to better categorise a variety of activities and highlights the necessary procedural requirements that follow.

Key factors are identified in the existing literature that help differentiate between quality improvement, audit and research. These factors range from intent in undertaking the activity, through sample/site selection, choice of methodology, analysis, patterns and speed of dissemination.

If quality improvement is to continue to be a central theme in the NHS agenda, it is important that both the Central Office for Ethical Review and NHS organisations review the categorisation system to include quality improvement in their clinical effectiveness structures.