NHS INTERVIEW GUIDE

Audit and Quality Improvement Interview Questions: How to Answer Them

A practical guide to audit, quality improvement and clinical governance questions in NHS interviews, with definitions, 12 practice questions and a worked STAR answer.

Last updated 24 October 2026 · Created by a practising NHS doctor · Independent of the NHS

Quick answer

How do I answer audit and quality improvement questions in an NHS interview?

Explain the difference between audit, quality improvement and research in one line each, then describe one real project using STAR. State your exact role, the standard or aim, what you measured, what changed and whether you re-audited. Mention PDSA cycles and clinical governance where relevant, link your work to patient safety, and finish with honest reflection on what you learned and would do next.

Key takeaways

Audit checks practice against a standard; research creates new knowledge.
QI tests small changes with PDSA cycles and measures over time.
Always say whether you closed the loop with a re-audit.
Be honest about your role, using 'I' for your own actions.
Link your project to patient safety and clinical governance.

To answer audit and quality improvement questions in an NHS interview, show that you know the difference between audit, QI and research, then describe one real project clearly: the problem, the standard or aim, what you measured, what changed and what you learned. Panels care less about the size of the project and more about whether you understand the method, worked with others and can say honestly what your own role was.

This guide covers the definitions panels expect, the audit cycle, PDSA cycles, the pillars of clinical governance, how to talk about a project you did or did not lead, 12 practice questions, a worked STAR answer, common mistakes and a short preparation plan. The questions are typical practice themes, not questions taken from any real interview.

In this guide

What is the difference between audit, quality improvement and research?
What is the audit cycle?
What is a PDSA cycle and the model for improvement?
What are the pillars of clinical governance?
How do I talk about an audit or QI project I did not lead?
What audit and quality improvement questions might I be asked?
What does a good STAR answer about an audit look like?
What do interview panels look for in audit and QI answers?
What are the common mistakes when answering audit questions?
How should I prepare for audit and quality improvement questions?

What is the difference between audit, quality improvement and research?

In short: research creates new knowledge about what works, audit checks whether you are doing what you already know works, and quality improvement tests changes to make care better over time. A one-line answer like this, followed by an example, is usually what a panel wants.

The three overlap, and many projects borrow from more than one. What matters is that you can explain which approach fits which question and why.

Research: asks 'what is the best thing to do?'. It tests a hypothesis, aims to produce findings that can be generalised, and normally needs formal ethics and research governance approval.
Clinical audit: asks 'are we doing what we should be doing?'. It measures current practice against an agreed standard, such as a national guideline or local policy, and usually needs registration with the local audit or clinical effectiveness team rather than research ethics approval.
Quality improvement: asks 'how can we make this better, and is the change working?'. It uses small, rapid tests of change and repeated measurement, often shown on a run chart, to improve a process in a particular setting.
Service evaluation: asks 'what does this service achieve?' without comparing to a standard. Mentioning it shows you know the full picture.

What is the audit cycle?

The audit cycle is a loop: choose a topic, set a standard, measure current practice, compare against the standard, make changes, then re-audit to see if practice has improved. The re-audit is what 'closing the loop' means, and panels often ask whether you did it.

1. Choose a topic: something important, common, high risk or costly, ideally linked to a known concern or incident.
2. Set the standard: taken from a national guideline, professional body standard or local policy, with a clear target.
3. Collect data: define your sample, time period and data source, and protect patient confidentiality.
4. Compare with the standard: analyse where practice falls short and why.
5. Implement change: teaching, a new form or prompt, a pathway change, agreed with the team.
6. Re-audit: measure again after the change and present the results so the cycle continues.

What is a PDSA cycle and the model for improvement?

A PDSA cycle (Plan, Do, Study, Act) is a small, quick test of one change: plan it and predict what will happen, try it on a small scale, study the results against your prediction, then act by adopting, adapting or abandoning the change. Several cycles are usually run one after another, each building on the last.

PDSA sits within a widely used model for improvement built on three questions. Learning these three questions gives you a clear structure for any QI answer.

What are we trying to accomplish? A specific, time-bound aim, for example improving completion of a safety checklist on one ward within three months.
How will we know that a change is an improvement? Outcome, process and balancing measures, usually tracked over time on a run chart.
What changes can we make that will result in improvement? Ideas from staff, patients and carers, often explored with a process map, fishbone diagram or driver diagram.
Then test with PDSA: start small, for one shift or one clinic, before spreading what works.

What are the pillars of clinical governance?

Clinical governance is the framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. It is commonly described as seven pillars, though different sources group them slightly differently, so focus on understanding rather than reciting a fixed list.

Clinical effectiveness and research: using evidence and guidelines in practice.
Clinical audit: checking practice against standards and improving it.
Risk management: incident reporting, learning from errors and reducing harm.
Education and training: keeping staff skills current, including supervision and CPD.
Patient and public involvement: listening to feedback and involving people in service design.
Information management: accurate records, data quality and confidentiality.
Staffing and staff management: safe recruitment, staffing levels and support for staff.
Tip: link at least one pillar to something you have done, such as reporting an incident or teaching a colleague.

How do I talk about an audit or QI project I did not lead?

Be honest about your role and describe your contribution in detail; panels respect a clear 'I collected the data and presented the results' far more than a vague 'we did an audit'. Use 'I' for your actions and 'we' for the team's.

If you have no project at all, say so, then show understanding: describe a gap you noticed, how you would audit or improve it, and what you plan to do in the new role. Many panels, especially for early career posts, accept this when it is thoughtful.

State your role in one sentence: lead, co-lead, data collector, presenter or the person who implemented the change.
Know the standard you used, your sample size and the headline result.
Explain what changed in practice, not just the numbers.
Say whether the loop was closed, and if not, why and what should happen next.
For senior and director roles, talk about how you supported, championed or embedded improvement across a team or service.

What audit and quality improvement questions might I be asked?

Expect a mix of knowledge questions and experience questions. Practise these aloud:

What is the difference between audit and research?
Can you explain the audit cycle?
Tell me about an audit you have been involved in. What was your role?
Did you close the loop? What happened at re-audit?
What is quality improvement, and how is it different from audit?
Describe a PDSA cycle you have used or would use.
What is clinical governance, and how does it affect your daily work?
How would you measure whether a change on your ward or service is an improvement?
Tell me about a time you identified a problem and changed practice.
What would you audit in this department, and why?
How do you involve patients or service users in improvement work?
What barriers have you faced in improvement work, and how did you overcome them?

What does a good STAR answer about an audit look like?

A strong answer follows STAR (Situation, Task, Action, Result) and ends with reflection and next steps. Keep it to about two minutes.

Worked STAR example: 'Tell me about an audit you have done'

Situation: On my ward, an incident review found that venous thromboembolism risk assessments were sometimes missed on admission. Local policy and national guidance say every eligible adult should be assessed within a set time of admission.

Task: I volunteered to lead an audit with support from a senior colleague and registered it with the trust audit team.

Action: I reviewed a sample of consecutive admissions over a month against the standard. Compliance was well below our target, and most gaps happened with out of hours admissions. I presented the findings at our team meeting, delivered short teaching sessions, and worked with the ward manager to add a prompt to the admission checklist. We tested the prompt for two weeks on one bay first, as a small PDSA cycle, then rolled it out.

Result: At re-audit three months later, compliance had risen substantially. I learned that changing the process mattered more than teaching alone. Next, I would add a run chart so we could spot any slippage early, and I handed the project over so it continued after my rotation.

What do interview panels look for in audit and QI answers?

Panels look for understanding of method, honesty about your role and evidence that patients benefited. These points often guide scoring:

Correct use of terms: standard, sample, re-audit, PDSA, measures.
A clear link to patient safety, experience or outcomes.
Teamwork and involving the right people, including patients where possible.
Measurable results, stated honestly, even if modest.
Reflection: what you would do differently and how you sustained the change.

What are the common mistakes when answering audit questions?

The most common mistake is describing data collection without any change or re-audit. Others are easy to avoid with preparation.

Mixing up audit and research, or calling a survey an audit with no standard.
Claiming to have led a project you only helped with.
Giving no numbers at all, or numbers you cannot explain.
Forgetting confidentiality and information governance.
Ending with 'and that was it' instead of reflection and next steps.
Reciting the governance pillars without linking them to real practice.

How should I prepare for audit and quality improvement questions?

Prepare one project in depth and the core definitions in outline, then practise saying both aloud. A week of short sessions is usually enough.

Day 1: write one-line definitions of audit, QI, research and clinical governance.
Day 2: draw the audit cycle and PDSA cycle from memory.
Day 3: write your project as a STAR answer with your role, standard, numbers and outcome.
Day 4: look at the trust's website and quality account for its priorities, and think of something you would audit there.
Day 5: practise the 12 questions aloud with a colleague, supervisor, mentor or careers adviser.
Day 6 and 7: refine and time your answers. Self-study resources such as Healthcare Interview Prep, which has practice question banks with model answers for 471 NHS roles, can add variety alongside free advice from NHS Jobs, your trust, royal colleges and professional bodies.

Frequently asked questions

Do I need ethics approval for a clinical audit?

Usually not. Clinical audit measures practice against an existing standard, so it normally does not need research ethics committee approval. However, it should be registered with your local audit or clinical effectiveness team and must follow information governance rules. If a project starts to look like research, for example testing a new treatment or randomising patients, check with your research and development office before starting. Local processes vary, so always follow your organisation's policy.

What if I have never done an audit before an NHS interview?

Be honest and then show understanding. Explain the audit cycle, describe a gap in practice you have noticed, and outline how you would audit it: the standard, sample, data and likely changes. Mention any related experience such as incident reporting, collecting data or teaching. Many panels, especially for early career roles, value a thoughtful plan and genuine interest over a project that you cannot explain well.

What does closing the audit loop mean?

Closing the loop means re-auditing after you have made changes, to see whether practice has actually improved against the standard. Without re-audit, you only know there was a problem, not whether your changes fixed it. In interviews, say whether you closed the loop. If you did not, explain why, for example a rotation ending, and describe how you handed the project over so it could continue.

Is a PDSA cycle the same as an audit?

No. An audit measures practice against a fixed standard at a point in time, then repeats the measurement after changes. A PDSA cycle is a small, quick test of a single change, with a prediction, a trial, a review and a decision about what to do next. Many projects combine both: an audit identifies the gap, then PDSA cycles test changes to close it, tracked over time.

How long should my answer to an audit question be?

Aim for about two minutes for an experience question and under a minute for a definition question. Use the STAR structure, give your role, the standard, the key result and what changed, then finish with a short reflection. If the panel wants more detail on your data or method, they will ask follow-up questions, so keep some facts ready rather than packing everything into the first answer.

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