The Clinical Audit & Quality Improvement Project Workbook
From a problem you noticed on the ward to a signed-off, portfolio-ready project.
The problem it solves
Every doctor in training has to complete an audit or quality-improvement project. The requirement is clear; the help is not. What is usually on offer is a dense guideline that explains the theory and leaves you looking at a blank page a week before your ARCP.
How it works
This workbook treats audit and quality improvement as one integrated cycle rather than two separate worlds, and carries a single worked project from first idea to portfolio entry while you build your own alongside it.
Who it is for
- Foundation doctors and residents with an audit requirement and an ARCP date
- Nurses and allied-health professionals running a ward-level improvement project
- Supervisors who keep sending the same project back for the same reasons
Who should look elsewhere. This is not a research-methods book. If your project is designed to produce generalisable new knowledge rather than to improve local care, you are doing research and need ethics approval — start with a research design guide instead.
What is inside
- Classifying the project — audit, quality improvement, or research — and taking the right governance route
- Registering it, and settling the ethics question before it costs you weeks
- Finding the standard: what good looks like, and where the criterion comes from
- A defensible baseline measurement, with a sample you can justify
- A SMART aim that carries a number and a date
- Driver diagrams and root-cause analysis: why the gap exists, not just that it does
- PDSA cycles as a ramp rather than a single test
- Run charts, and the rules that separate signal from noise
- The re-audit, measured like for like so the comparison means something
- Writing up to SQUIRE 2.0, plus abstract, poster, and a curriculum-mapped portfolio entry
What you will have finished
- A correctly classified, registered project on the right governance route, with the ethics question settled
- A SMART aim with a number and a date, resting on a defensible baseline
- A driver diagram and root-cause analysis explaining why the gap exists
- A PDSA improvement ramp and a run chart that distinguish real change from noise
- A like-for-like re-audit that closes the loop
- A SQUIRE 2.0 write-up, an abstract and poster, and a supervisor-signed portfolio entry mapped to your curriculum
What this adds to the free guidance
HQIP guidance, the IHI Model for Improvement and the SQUIRE 2.0 checklist are all free, and all of them describe the destination rather than the route. They tell you a project needs a defensible baseline; they do not sit with you while you choose a sample size, or tell you that measuring the re-audit differently from the baseline is the single most common reason a project is rejected. This workbook is the coaching around those standards, one page at a time.
Built on HQIP, IHI Model for Improvement, SQUIRE 2.0. Original tools that operationalise the published standards and point to the free official sources.
Frequently asked questions
Is this audit or quality improvement?
Both, deliberately. Most trainees are told to do one and end up doing the other, because in practice they are one cycle: you measure against a standard, you find a gap, you change something, you measure again. Treating them as separate worlds is what produces audits that never improve anything and QI projects with no baseline.
Do I need ethics approval?
Usually not, but the answer depends on classification rather than on topic — and getting it wrong in either direction is expensive. A project intended to improve local care against an existing standard is normally service evaluation or audit, and takes a governance route rather than an ethics one. The first chapter settles this before you invest any time.
What if my re-audit shows no improvement?
That is a finding, and a publishable one. What makes it worthless is not being able to say why — which is what the driver diagram and root-cause work exist to prevent. A project that shows no change and explains the mechanism is stronger than one that shows improvement it cannot account for.
Will this satisfy my portfolio requirement?
The final chapter produces a supervisor-signed entry mapped to curriculum competencies, which is the form most training programmes ask for. Requirements vary by deanery and specialty, so check yours against the mapping rather than assuming.