Making Quality Improvement core business in healthcare

Welcome to the third NQICAN blog – its great to see that our readership & the debate is growing across our previous blogs (intro & beware of samples) and I know this one will be of similar interest.

Since taking up the role of N-QI-CAN chair in Nov 2015 – one of the main publications for various reasons has been the AoMRC report on Quality Improvement – training for better outcomes.


In summary the report has highlighted the importance of making quality improvement an integral part of the core business of healthcare, with a focus on those in medical training as a starting point. NQICAN have been involved in the development of the report from its outset – taking part in the focus groups held in 2015.

Following publication of the report we invited the medical lead Dr Emma Vaux to our June NQICAN meeting to present the report – and we (via our clinical audit networks) were then asked to review the report and make suggestions of how clinical audit professionals could support the recommendations going forward. Whilst the principles of the report were supported by NQICAN – we & the majority of the clinical audit community felt that the report had been over critical of clinical audit throughout the document with no clear references from the literature linked to the negative statements made.

I set up a NQICAN sub-group to review the feedback received following the networks consultation – which included discussions at NQICAN and feedback from Clinical Audit Support Centre (who are members of our EMCASNet) – and send this back to AoMRC via Dr Vaux – highlighting our general comments on the document along with our suggestions of how clinical audit / QI professionals can support the recommendations going forward.

I am pleased to say we have received a positive response from Dr Vaux – who has agreed for us to publish our response to the document alongside her response in full (link) given the strength of feeling from the clinical audit networks.

We will be discussing the response further at our next NQICAN meeting on the 9th March so please take time to review our correspondence to date & leave your views/ideas in the comments below or send them direct to me via

This piece of work and subsequent discussions have certainly highlighted to us how clinical audit is often mis-perceived / mis-used / mis-understood etc. and how it varies in practice. There is a real need to have a clear common QI language going forward as suggested by Dr Vaux reply. Clinical audit is without doubt a quality improvement process but is not the only tool in the QI toolbox (see recent HQIP publication).  Together we need to ensure that relevant staff are adequately trained to decide which tool is most appropriate for the project & aims they are working on.

I think we all agree QI should be “an integral part of the core business of healthcare” and we look forward to being part of the plan to role this out and supporting the AoMRC working groups going forward.

I would like to thank the network members who took time to feedback and also members of the NQICAN sub-group & Dr Vaux.


Carl Walker, NQICAN chair @cwwalker10


  1. ‘In current work we are doing with HQIP, using national clinical audit (NCA) as the catalyst for improvement in our LTMD beyond CMT programme, less than 5% trainees have heard of NCA. None have heard of HQIP.’

    Not sure who this shows in a worse light: those on the CMT programme who have never heard of HQIP and NCAs or HQIP and NCA providers for clearly not getting their message out!

  2. Can you confirm that the timelines are correct in this blog? Dr Vaux attended an NQICAN meeting in June 2016 and NQICAN provided her with comments in January 2017. Dr Vaux replied by letter 11 days later! If this is correct then Dr Vaux should be commended for her dynamism whereas NQICAN look ponderous and inefficient.

    1. Yes the timelines are correct. Please email us if you would like further information around our process for responding as it has been complex as Carl mentioned in the blog hence the “ponderous” response.

  3. Well done to Carl and NQICAN for this blog and for fighting the corner of local clinical audit staff who correctly view this as an ‘over-critical’ and some would say unfair attack on clinical audit. We are happy to have many of our views included in the NQICAN linked document as the report is unreferenced and is unproven in many cases. For example the graphs to assert the value of QI are meaningless. They would be akin to illustrating a rising share price with an upward line graph but not citing the relevant share! This is simply made up data to make a point.

    As regards the comment above: NQICAN are a group of volunteers who get a small amount of annual funding to undertake their duties. AOMRC are not in the same league and one can only wonder how much money was spent on compiling this report and the associated printing costs.

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