Abstract <p>Clinicians have an ethical responsibility to improve care while safeguarding patients from harm. This ethical imperative drives the implementation of Quality Improvement (QI) initiatives aimed at enhancing patient outcomes. In comparison to human subjects’ research, QI efforts may have different ethical considerations that seem less well defined. This article explores the ethical complexities in neonatal and perinatal QI work associated with designing, conducting, and disseminating QI projects. QI efforts should be grounded in ethical tenets such as beneficence, non-maleficence, justice, and respect for autonomy particularly when applied to vulnerable populations such as neonates. By recognizing the ethical considerations unique to QI, investigators can promote transparency and context-aware practices, thereby improving the rigor, reproducibility, and safety of their initiatives. Thoughtful design and implementation can ensure that QI efforts are both ethically sound and clinically impactful, enhancing their trustworthiness and applicability across diverse clinical settings.</p> Clinical Trial Registration (if any) <p>None.</p>