After over a decade of investment in clinical audit in the NHS, it might seem a little late for the National Institute for Clinical Excellence (NICE) to be publishing a book on how to do it. In the foreword by NICE there is a clue to the reason why. It says, rather charitably, that audit has a “mixed record”, and then goes on, less charitably, to list its flaws and shortcomings. A litany of problems is recited—including poor project design, inadequate data, bad project management, lack of commitment, poor change …