We constantly talk in our staff rooms and on our tea breaks across primary care services about how to improve the way we provide care. Forms are redesigned and processes are tweaked. Do things improve? All improvement requires change but not all changes are an improvement. 1 Did our improvement efforts achieve positive results? Which methods of quality improvement work best? What are the contextual factors which affect success? Rigorous scientific enquiry into these questions is called quality improvement research (QIR). See Box 10.1 for some definitions of QIR and related terms.