Commitment to quality improvement and the delivery of safe care sit at the heart of professional nursing standards, including the NMC Code and Standards of Proficiency for Registered Nurses.

This focus is made clear in Platform 6, Improving safety and quality of care, within the NMC Standards.

Quality improvement is a structured way to make care better. It focuses on:

• setting a clear aim
• testing changes in small steps
• using learning and data to adapt what you do
• repeating the cycle until you get a measurable improvement in care.

You can read a practical introduction in Quality Improvement into Practice.

Both quality improvement and clinical audit support better care, but they do different jobs.

Quality improvement is about making change happen:

• It tests ideas, learns quickly and adapts to what works in your setting.

Clinical audit is often used to check whether care meets an agreed standard:

• It can act as quality assurance by measuring practice against criteria, then re-measuring after changes.
• Audit findings can also be used to support improvement work, especially when combined with iterative tests of change.

Change is central to quality improvement, but it is not always easy to sustain. Common challenges include:

• aims that are too broad or unclear
• not understanding the current process before trying to fix it
• too little time or support to plan, test and measure change
• limited staff involvement or weak communication
• stopping too early, before the change is embedded.

A useful guide to get started

The Health Foundation guide, Quality Improvement Made Simple, explains common quality improvement methods, the principles behind them, and practical factors that help make improvements stick.

Leading successful change takes good leadership. Janes and Delves-Yates (PDF) outline values and behaviours you need to incorporate into your practice when driving quality improvement initiatives that involve change.

They present these as the 11 Cs for leading change:

• Clarity: Communicate the need for change with simple, accurate language.
• Critical Thinking: Validate assumptions and seek evidence-based solutions.
• Culture: Respect team and organisational culture and diversity.
• Collaboration: Build open, inclusive relationships with all stakeholders.
• Communication: Share the purpose while listening actively and fostering trust.
• Courage: Tackle challenges, manage conflict and delegate with confidence.
• Commitment: Role-model values and stay dedicated to the change process.
• Compassion: Show empathy and support to everyone involved.
• Confidence: Take responsibility and maintain perspective and positivity.
• Creativity: Develop innovative and practical solutions.
• Credibility: Lead with honesty, transparency and expertise.

Theories of change are essential tools to help guide improvement. They provide a structured approach to understanding how change occurs and how interventions can influence that change.

Take a few minutes to watch these two short videos for a practical explanation of Edwards Deming’s Theory of Profound Knowledge. They explore why change in health care is complex and how understanding these principles can help you lead improvement with confidence. By applying these ideas, you can strengthen patient safety, improve teamwork, and drive positive changes in everyday practice.

Part 1: Deming's System of Profound Knowledge 1

Part 2: Deming's System of Profound Knowledge 2

Theories to support you in leading change and initiating improvement in the workplace include:

PDSA/PDCA Cycle 

The PDSA (Plan–Do–Study–Act) or PDCA (Plan–Do–Check–Act) cycle provides a structured, four‑step method for testing and improving changes. Through repeated cycles of planning, trying out a change, evaluating the results and adjusting accordingly, teams can build and sustain better processes over time. 

The diagram is adapted from: Langley, et al., (2009). The improvement guide: a practical approach to enhancing organizational performance. 

Kotter’s 8 Steps for Leading Change

John Kotter’s 8‑step process is a well‑established framework for leading successful organisational change. It focuses on people—recognising the cultural, emotional, and behavioural aspects that influence change. The model sets out eight steps that help leaders deliver meaningful, lasting transformation:

• Create a sense of urgency to motivate action.
• Build a strong change team with diverse skills.
• Define a clear strategic vision.
• Communicate roles and purpose effectively.
• Identify and address barriers.
• Set short-term goals for quick wins.
• Maintain momentum during implementation.
• Embed new approaches to sustain change.

Taken and adapted from Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Lewin’s Change Management Model

Kurt Lewin's change management model, developed in the 1940s, is a three-stage model—'Unfreeze, Change and Refreeze’—designed to move organisations from a current state to a desired future state. It emphasises preparing for change, implementing the transition through communication and training, and stabilising new behaviours as the new norm.

Lewin's three-stage model:

Take a moment to reflect on the following questions:

• In what ways do I currently contribute to improving safety and quality in my area of practice?
• What barriers (personal, cultural, organisational) have I encountered when trying to influence or lead change?
• When planning a change, how often do I consider the wider system—and any unintended consequences—beyond my immediate team?
• Where in my daily work do I notice opportunities for small, incremental improvements?
• What stops these from being acted on, and what one small step could I take to change that?

RCN Foundation Quality Improvement grant

Are you planning to undertake a Quality Improvement project? The RCN Foundation may be able to help with funding to support you. The project funds opportunities for nursing and midwifery-led QI projects that seek to improve patient care and safety, help in addressing health inequalities and improve outcomes for nurses and midwives’ wellbeing.

The RCN Foundation seeks to fund up to eight QI projects across the UK on an annual basis. To find out if you are eligible to apply, visit The RCN Foundation website.

Quality improvement in healthcare: a guide for students and practitioners. SAGE Publications, Kordowicz, M., & Siriwardena, A.N. (2023).

This book introduces quality improvement for anyone studying or working in health care. Written in clear, straightforward language, it explores quality improvement from multiple perspectives and outlines a range of models and toolkits you can use in practice.

Oxford professional practice: handbook of quality improvement in healthcare. Oxford University Press, Lachman, P. (2024).

This book covers the most modern theories and methods of improvement and implementation science in health care today.

Quality measures: the revolution in patient safety and outcomes. Springer, Salem, D. N., Freund, K. M., & Weingart, S. N. (2020).

This book offers the perspective of the health care provider and aims to fulfil the unmet need to educate other health care providers on recognising quality measures and understanding how to achieve them to meet standards of quality care.

Leading sustainable quality improvement. Nursing Management, 52(2), p. 42-50, O'Donoghue, S. C., DiLibero, J., & Altman, M. (2021).

This article explores common causes of quality improvement project failure and key strategies for success, including partnering with a clinical nurse specialist to facilitate sustainable change.