Clinical audit and quality improvement: rivals, partners, or one and the same?

Clinical audit and quality improvement are both central to improving healthcare quality; however, there is often a lack of conceptual clarity about their similarities and differences. They are frequently misunderstood, conflated, or applied in ways that do not match their primary purpose. In the United Kingdom, this lack of conceptual clarity is evident across clinical practice, healthcare improvement literature, and professional curricula. The misapplication of methods may contribute to inefficient use of resources and missed opportunities to improve experiences and outcomes for patients, families, and staff. This practice-informed perspective article clarifies the distinct purposes and roles of clinical audit and quality improvement before demonstrating how they can be used in practice. Drawing on published literature, professional guidance, and the authors' practical experience, we examine the key similarities, differences, and common points of confusion between clinical audit and quality improvement. We highlight recurring challenges faced by UK healthcare professionals when selecting and applying these approaches in real-world settings, as a call for international reflection. We present a decision aid to support intentional and effective method selection and purposeful transition between approaches. By providing clarity on how clinical audit and quality improvement are distinct yet complementary, this article aims to support more rigorous, contextually appropriate, and impactful improvement efforts across all healthcare systems.