The evolution of quality assurance.

The evolution and maturity of quality assurance in healthcare remains largely unstudied and undocumented, in comparison to the literature about quality improvement. This article describes the development in thinking around quality assurance over the last four decades - from the first structured organisational framework that made boards accountable for quality, through the clinical governance system set up in the 1990s. Clinical governance brought together a range of disparate components into a coherent structure, which we would largely view as quality assurance today. As practice and learning about quality management has evolved in the subsequent decades, there is an appreciation of the need to balance quality assurance with other elements of quality management - improvement, control and planning. The article presents a detailed case study from East London NHS Foundation Trust which describes how modern quality assurance has become much more patient-led, informed by improvement science, and meaningful, through reducing burden and involving clinicians in quality assurance activities.