The background to and content of the recent policy initiatives influencing the quality agenda in the NHS in England are analysed in this article, focusing on the theoretical conceptualisation of the term quality. The authors share their experience of developing and implementing a nursing and midwifery quality improvement framework at Imperial College Healthcare NHS Trust, London, as an innovative method of supporting quality assurance by using a service improvement method. The successes and challenges of the project are discussed, and areas where the framework can be developed further to support sustainable improvements in quality are identified.