This occasional paper is the sixth in a series on the National Quality Framework (NQF). It examines trends in quality improvement from the perspective of services rated Working Towards National Quality Standard (NQS) under the 2012 NQS. In this paper, a service is considered to have improved its quality at reassessment where it: (1) receives a higher overall quality rating; (2) receives a higher rating in a quality area; and (3) meets a higher number of elements of quality. Qualitative analysis suggests primary drivers of quality improvement include the recruitment and retention of highly trained educators that have a good understanding of the NQF, delivering education and care under the direction of high quality service leadership. Case studies describing quality improvement practices that were evident during reassessment have been included in this paper. These case studies are intended to aid and support the process of continuous quality improvement and the ongoing development of quality improvement plans (QIPs).