This chapter explains why quality assurance is essential if screening is to do more good than harm. It describes some of the history and thinking that has shaped approaches to quality in industry and in healthcare, starting with an example from the American car industry and focusing on two founding fathers of quality - W Edwards Deming, and Avedis Donabedian. It outlines Donabedian’s seven components of quality, and shows how these encompass the notion of best value in healthcare so that efforts are devoted to improving health and social justice. It then goes on to explain some of the ways of measuring screening quality, setting standards and ensuring standards are met. It uses case histories and practical examples so that the reader can easily apply the lessons in their day to day work.