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The quality assurance cycle

One of the outcomes of the ‘quality movement’ has been the development of a specialised bureaucracy to ensure smooth operation of (often complex) quality systems including apparatuses for audit and accountability. Quality assurance systems, whether at system, organisational or individual level, typically operate within a cycle which reflects the ‘plan – do – reflect – review’ cycle used across healthcare (see Figure 2).

Quality assurance agencies expect staff at all levels in institutions (including classroom and clinical teachers) to gather data that allow them to demonstrate these steps and the manner in which each step affects and feeds into the next.

Figure 2   The quality assurance cycle

Key features of the quality assurance process

Regardless of the agency or the object of scrutiny, there is a reasonably common approach to reviews, be they audit, approval or accreditation. The key features of quality assurance include:

  • Self-evaluation – usually through a review report in which the institution provides a self-assessment of its activities relating to the scope of the review
  • External expert review conducted by an autonomous agency – usually involving documentary scrutiny and a visit by reviewers to the institution
  • The public report – with commentary and recommendations
  • Benchmarking – periodic reviews by the agency across the sector to identify common themes and issues.


While most review and evaluation systems are developed on the basis of promoting on-going improvement, review systems need to be robust enough to stop under-performing institutions, subjects or programmes from receiving monies from governments or other funders or from taking students.


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