Evaluation, audit and quality improvement are closely related approaches to understanding whether health and care services are working effectively.
This toolkit supports evaluation work, though many of the tools and resources can also support audit and quality improvement activities.
What is evaluation?
Evaluation addresses strategic questions about whether to continue, scale, or fund an intervention. Unlike audit (which checks compliance) or quality improvement (which tests changes), evaluation explores whether and how something works, and why.
Evaluation asks:
- Should we continue this intervention?
- Is it having the intended impact and why?
- How can we improve it?
- Should we scale it or share it with others?
- Is it delivering value for money?
Key characteristics:
- Explores whether and how an intervention works, and why
- Uses both new data collection and existing data sources
- Supports decisions about funding, continuation and scale-up
- Conducted to inform strategic judgement rather than routine management
- Captures learning that can benefit others beyond the local context
Evaluation can use existing data: You can draw on routinely collected audit and performance data for your evaluation. This reduces the burden of additional data collection whilst building a deeper understanding of your intervention’s impact.
Example: Sheffield Teaching Hospitals NHS Foundation Trust used existing bed occupancy monitoring data as part of evaluating patient flow interventions, but went further to understand why changes were working and which components were most effective.
What is audit?
An audit investigates whether a service or activity meets agreed standards, and identifies where improvements can be made. Standards may be set internally by service providers or externally by bodies like National Institute for Health and Care Excellence (NICE).
Key characteristics:
- Measures against predetermined standards or guidelines
- Focuses on compliance and quality assurance
- Usually applies to a specific context (local, regional or national)
- Results identify gaps and areas for improvement
- Typically part of routine governance processes
Example: The National Diabetes Audit measures diabetes healthcare against NICE Clinical Guidelines and Quality Standards across England and Wales.
What is quality improvement?
Quality improvement (QI) uses systematic methods to make changes that lead to better patient outcomes, system performance and professional development. It often uses iterative testing cycles such as Plan-Do-Study-Act(PDSA) to understand what works.
Key characteristics:
- Focuses on continuous, incremental change through testing
- Uses rapid improvement cycles with regular measurement
- Emphasises frontline staff engagement in the change process
- Aims to embed sustainable improvements in day-to-day practice
- Typically conducted by teams doing the work, not external evaluators
Example: A hospital ward testing different approaches to reduce patient falls, measuring results weekly and adapting interventions based on learning.
Key principle
Many real-world projects combine elements of evaluation, audit and quality improvement. If you are trying to understand whether something works and make evidence-based decisions about its future, you are conducting evaluation work, and this toolkit can support you.
Next steps: Start with the Evaluation Design Tool to receive tailored guidance on the evaluation approach you need, then follow the Step-by-step-guide.