12 Feb 2026

Patient representative, Sadia, tells us why patient voice and data must shape healthcare improvement.

When Sadia first came across HQIP’s Service User Network (SUN), she wasn’t particularly looking for a new commitment – but she was keen to make a difference. Having taken part in patient engagement activities for a local research initiative previously, she was ready to contribute to something broader; something that would have national impact. What she found was a community where her voice – and the voices of people like her – could help shape the quality of healthcare across the country for everyone. Here she explains why patient involvement is important, and why it goes hand in hand with sharing healthcare data.

We’re the ones receiving the care. We’re the only ones who can tell you if it’s working or not” 

“When I saw the SUN network, it sounded exactly what I was looking for.” What stood out to her first was the tone of the advert: welcoming and flexible. “It said I could be involved as much or as little as I wanted. That really reassured me; it meant that I could contribute as and when I was able.” She signed up immediately. It was the beginning of a relationship that brought benefit to HQIP’s programme of national clinical audits as well as wider healthcare. It was also a relationship that saw Sadia develop her understanding of the value of patient voice, and the use of data, in changing healthcare for the better.

Why patient voice matters

For Sadia, the case for involving patients in healthcare improvement is simple and powerful. “We’re the ones receiving the care. We’re the only ones who can tell you if it’s working or not.” She has seen first-hand how involving patients early can prevent problems later on, and save time and effort. “If you include patients in discussions around care initiatives, they’ll spot issues before you roll them out – and they’ll help you to fix them. It makes care relevant, more efficient, and ultimately supports staff too.”

Improving care for everyone

Sadia, who has premenstrual dysphoric disorder (PMDD, a condition that took 12 years to be diagnosed), speaks candidly about her healthcare journey. As a British-South Asian woman under 30, she has faced many assumptions about her and her care. But change, she says, is happening. In her case, she connects this directly to women’s involvement. “When I was growing up, most research was done by men, for men, about men. Now we’re seeing much more research led by women, and that is focused on women’s health – and the involvement of female patients has played a key role too.” She believes that change has been possible in part because patients have demanded to be part of the solution: “We go through this, you should be studying us with us.”

I can see that sharing [anonymised] data is an important part of creating better services and outcomes” 

Today, when she visits her doctor, they immediately know what PMDD is and what emerging treatments are being explored. “It gives me hope. Five or ten years ago, that wouldn’t have happened, and I’m grateful – not just for me, but for all the others with my condition.”

How data shapes better care

Sadia is open about once feeling hesitant about consenting to sharing her health data. “Healthcare hasn’t always focused on people like me, so I was unsure if it would be of benefit. But, through being involved with HQIP, I can see that sharing [anonymised] data is an important part of creating better services and outcomes.” For her, data and patient voice are equally important: “You need both to understand how care is working and where improvements are needed.” She also sees data sharing as essential to equity. “If someone like me doesn’t share my data, there won’t be relevant information to shine a light on conditions that affect people like me.”

What does patient engagement mean in practice?

Since joining HQIP’s Service User Network (SUN), Sadia has taken part in a wide range of activities, including reviewing reports, contributing to the development of resources, speaking at conferences, and generally offering insights based on both her personal experiences and those of people for whom she cares. “My father has cardiovascular disease, and I have been able to contribute, not just as a patient but also as a carer. Being able to bring that perspective into a meeting, and see it valued, was fantastic.”

If you’re listening to your patients, you’re going to get things right more often” 

The variety of opportunities is something she genuinely appreciates. “I feel like I’ve only touched the surface, in terms of what I could get involved in. But the great thing is, if you aren’t selected for one opportunity, another comes along quite soon. It is always very rewarding.”

A shared journey to continuous improvement

While Sadia says that she wouldn’t have chosen to go through the healthcare journey she has, she recognises that it does put her in a unique position of being able to benefit others, through patient engagement. “It did lead me to something meaningful,” she reflects. She is comforted that she is helping to shape a healthcare service that listens, learns, and improves.

For HQIP, Sadia’s story embodies exactly why patient involvement is critical for patient-centred, evidence-informed improvement in care. It deepens understanding. It ensures relevance. And, ultimately, it leads to care that meets the needs of real people. Or, as Sadia puts it: “If you’re listening to your patients, you’re going to get things right more often.”

Further information

• HQIP’s Service User Network (SUN)
• More about patient engagement at HQIP
• HQIP-commissioned national clinical audits and programmes
• Reports from HQIP programmes on a range of topics, from asthma to vascular care
• Article: How the National Audit of Eating Disorders (NAED) is placing the voices of people with lived experience at the centre of its work
• Patient POV: HQIP patient advocate, Aurora explains how she and her peers are guiding national obesity care
• Article: The Power of Patient and Public Involvement (PPI) in Healthcare Improvement
• Patient voice in clinical audit: A powerful partnership improving asthma and COPD care

1 Feb 2026

HQIP Associate Director, Dr Iain Smith, features in BMJ Leader Blog this month, on the subject of integrating clinical audit and quality improvement to deliver impact for patients…

“Fit-for-the-Future, the ten-year plan for the English NHS, envisages a focus on quality and improvement driven by data.¹ The plan acknowledges the wealth of data available nationally – including through clinical audits.¹ Furthermore, new best practice guidance from NHS England argues for clinical audit contributing to a wider quality management approach.²

Data are critical to both quality improvement and quality assurance. When used effectively, data enable organisations to demonstrate measurable improvement at both the individual project and whole organisation level.” Samantha Riley, Director of Making Data Count, NHS England

Historically, clinical audit is one of the main mechanisms for improvement in healthcare and is closely associated with quality assurance. More recently, approaches to quality improvement have been adopted into healthcare from other industries focussing on small-scale tests of change and learning – typically with measurement as a key element.³ Whilst tensions between clinical audit and other quality improvement approaches have been observed, both can work in synergy and clinical audit can play a key role in moving towards more systematic data driven quality management.^{2 4}

Background: Clinical Audit and Quality Management

Continuous improvement is a long pursued goal in healthcare.⁵ A long standing approach to improvement is clinical audit.  Clinical audit involves assessing services against evidence-based criteria and is considered the foundation of a well-functioning healthcare system. It is a cyclical approach that provides feedback upon which action can be taking on areas for improvement before re-auditing to assess the impact (see Figure 1 below).^{2 6 7}

Improvement efforts are more impactful when part of a systematic approach.^{8 9} Quality management systems (QMS) are a means of systematically improving healthcare and embedding continuous improvement. A QMS combines a systematic approach to quality improvement (QI) with quality planning and quality control.^9-11 Quality planning refers to how an organisation or system identifies its priorities for improvement and designs interventions to deliver them.¹⁰ Quality planning ensures close alignment of improvement activity with the strategic objectives of the organisation or system.^{10 11} Quality control refers to measurement of processes to monitor performance in real time and taking action to deliver results in line with performance standards.^{10 11} In addition to these three core components of a QMS, in healthcare a fourth component is included. Quality assurance focuses on checking whether a service is meeting required standards based on external requirements.^{9 11} Clinical audit can play a key role across such systematic approaches.¹²

Figure 1 – The Clinical Audit Cycle (HQIP 2020, used with permission)

Clinical Audit and Quality Planning: Identifying opportunities for improvement

Clinical audit can support progress on national healthcare priorities by considering findings in planning activities. Clinical audit can contribute insights to service planning and commissioning processes by providing both cross-sectional benchmarking and longitudinal data.^{1 2} The national clinical audit and outcomes programme (NCAPOP) is one of the largest national audit programmes of its kind and can play a major role in the planning process and identification of improvement priorities.¹² If healthcare priorities are to be evidence-based, clinically credible and focused on what matters most to patients, this data should shape how services are designed and inform which improvement priorities are selected. For example, the national mothers and babies audit (MBRRACE-UK) identified persistent inequalities in maternal and perinatal outcomes linked to ethnicity, deprivation, and geography. These findings enabled providers, commissioners and national bodies to prioritise targeted improvement efforts focussing attention on highest risk groups.^{13 14}

Clinical Audit and Quality Improvement: Improving patient care and outcomes

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes. A long-standing approach that has stood the test of time, clinical audit can continue to play a leading role in improving processes and outcomes nationally and locally. Through assessment against evidence-based standards for the structure, processes and outcomes of care, changes can be implemented where indicated and monitored to confirm improvement.⁷ Clinical audit also works alongside other popular approaches to QI – such as Lean and the Model-for-Improvement. These approaches support experimentation and testing in the ‘implementing change’ stage of the audit cycle.⁴ Therefore, if we want improvement that is data-driven, evidence-informed and clinically trusted, clinical audit should be central to any systematic QI approach. For example, the fragility fracture and falls audit programme (FFFAP) provides the national audit of inpatient falls (NAIF) which has seen improvements in its key indicators over the past six years. NAIF also provides resources to support local quality improvement projects.¹⁵

Clinical Audit and Quality Control: Ongoing measurement of quality

Clinical audit supports quality control processes by providing evidence of impact of changes introduced. In improvement work, to assess tests of change, a family of metrics is used comprising process and outcome measures.³ Audit is ideally placed to contribute to this and help improvement efforts to know whether changes lead to improvement. Whilst audits have been carried out previously at distal points in time, such as annually, there are examples of audits operating more frequently. With increasing focus on digital technologies, further shifts towards real-time audit are anticipated.¹ For example, the paediatric intensive care audit network (PICANet) provides continuous, risk-adjusted monitoring of outcomes, allowing providers and national bodies to track trends in mortality, detect variation and identify emerging quality concerns.¹⁶

Clinical Audit and Quality Assurance: Evidence based compliance with standards

Quality assurance processes help organisations to understand care quality through periodic checks that particular standards are being achieved and addressing identified shortfalls.^{2 11} Alongside inspection and accreditation, clinical audit is one of the main quality assurance mechanisms used by healthcare organisations.^{4 11} Clinical audit is effective for providing assurance of compliance with evidence-based standards – including national standards via national audits.

Clinical audit is one of the earliest forms of QI in healthcare. Whilst typically associated with quality assurance, clinical audit can play a key role across all quality management domains including planning, control and improvement. To provide confidence that care is consistently safe, effective and improving over time, clinical audit should underpin how we improve and monitor for proactive oversight and quality control.”

This article was published as a blog on BMJ Leader on 9th Feb 2026: Quality management and clinical audit: Integrating clinical audit and quality improvement to deliver impact for patients. By Iain Smith – The official blog of BMJ Leader

Further resources from HQIP

• Discover more about how HQIP supports organisations to use clinical audit and healthcare data to drive improvement – from strategy development to implementation or training
• Guidance and other resources to support improvement
• Reports and infographics
• Benchmarked results, searchable by project name, trust, hospital or unit

References

1. Department of Health & Social Care and NHS England. Fit for the future: 10 Year Health Plan for England. London: UK Government, 2025.
2. NHS England. Clinical audits and registries: A best practice guide. London: NHS England (Available at https://future.nhs.uk ), 2026.
3. Shah A. Using data for improvement. BMJ 2019;364:l189. doi: https://doi.org/10.1136/bmj.l189
4. Backhouse A, Ogunlayi F. Quality improvement into practice. BMJ 2020;368:m865. doi: https://doi.org/10.1136/bmj.m865
5. Berwick D. Continuous Improvement as an Ideal in Healthcare. New Engl J Med 1989;320(1):53-56. doi: https://doi.org/10.1056/nejm198901053200110
6. Ivers N, Foy R. Audit, Feedback, and Behaviour Change. Cambridge: Cambridge University Press, 2025.
7. HQIP. Best practice in clinical audit. London: Healthcare Quality Improvement Partnership (Available at www.hqip.org.uk ), 2020.
8. Dixon-Woods M, Martin GP. Does quality improvement improve quality? Future Hospital Journal 2016;3(3):191-94. doi: https://doi.org/10.7861/futurehosp.3-3-191
9. Spela Godec MH, John Illingworth, Carl Macrae. Developing whole-organisation Quality Management Systems in health care: learning from practice and recommendations for progress. London: The Health Foundation, 2025.
10. Glassborow R. Moving from Quality Improvement to Quality Management: Supporting better quality health and social care for everyone in Scotland. Edinburgh, UK: Healthcare Improvement Scotland (Available at www.ihub.scot ), 2022.
11. Shah A. How to move beyond quality improvement projects. BMJ 2020;370:m2319. doi: https://doi.org/10.1136/bmj.m2319
12. Clark CI. Healthcare data: The key to improvement and efficiency [Blog]. London: BMJ Leader; 2025 [updated 03 Dec 2025. Available from: https://blogs.bmj.com/bmjleader/2025/12/03/healthcare-data-the-key-to-improvement-and-efficiency-by-dame-celia-ingham-clark accessed 19 Jan 2026 2026.
13. MBRRACE-UK. Maternal mortality 2022-2024 Oxford: National Perinatal Epidemiology Unit; 2026 [updated 15 Jan 202627 Jan 2026]. Available from: https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2022-2024.
14. NHS England. The Maternal Care Bundle: A care bundle for reducing maternal mortality and morbidity London: NHS England; 2026 [updated 16 Jan 2026. Available from: https://www.england.nhs.uk/long-read/the-maternal-care-bundle/ accessed 26 Jan 2026.
15. National Audit of Inpatient Falls (NAIF). Stepping towards improvement: an analysis of 2024 inpatient falls audit data and reflection on 6 years as continuous audit. London: Royal College of Physicians (Available at https://www.rcp.ac.uk/86396 ), 2025.
16. Universities of Leeds and Leicester. The Paediatric Intensive Care Audit Network (PICANet): PICANet; 2026 [Available from: https://www.picanet.org.uk accessed 27 Jan 2026.