The quality of care is a major focus for healthcare providers, in part to demonstrate to those who use their services that they can be trusted to deliver good care, and in part to satisfy the requirements of their funders and regulators who set necessary standards of care. Consequently, methods and processes have been developed to describe, assess and improve the quality of care. This chapter aims to understand the quality agenda in relation to spirituality and the practice of spiritual care. It begins by looking at how characteristics of quality healthcare can be applied to spiritual care and considers a range of quality standards and how they incorporate spiritual care. Clinical audit is reviewed as a popular method for evaluating and improving quality and its application to spiritual care, including a critical look at the use of outcome measures. Finally other approaches and challenges to quality improvement are considered including understanding the knowledge translation gap and the use of an improvement model.