Sustainability in Quality Improvement
Sustainability in Quality Improvement (SusQI) is an approach to improving healthcare in a holistic way, by assessing quality and value through the sustainable value lens. In SusQI, the health outcomes of a service are measured against its environmental, social and economic costs and impacts to determine its “sustainable value”.
The sustainable value equation is not designed to be solved, or reduced to a single number. It should be used to guide holistic thinking, so that all aspects of the equation are considered in quality improvement projects.
The SusQI Framework
Sustainability in QI (or SusQI) recognises that there are finite environmental, social and financial resources available to deliver a high standard of patient care. The overall goal of incorporating sustainability into quality improvement is to maximise sustainable value. This means to deliver the best possible health outcomes with minimum financial, environmental and social resources, while adding positive social value at every opportunity. SusQI embeds The Principles of Sustainable Healthcare: prevention, patient empowerment and self-care, lean clinical pathways and low-carbon alternatives.
How SusQI fits with Quality Improvement
Rather than being a replacement for traditional QI, SusQI is designed to embed sustainability into current QI theory and practice, and thus provide practical tools to support healthcare staff in contributing to health-system transformation.
Including sustainability and resource stewardship into QI allows health professionals to respond to the ethical challenges of climate change and social inequalities. It also benefits the QI process itself: inspiring new energy for change, highlighting waste and opportunities otherwise overlooked, and directing projects systematically towards the highest value improvements.
“Healthcare should be considered not only in terms of what can be delivered to an individual today, but also to the population in general and the patients of the future.”
Atkinson S, Ingham J, Cheshire M, Went S. Defining quality and quality improvement. Clinical Medicine. 2010 Dec;10(6):537.
Why is sustainability needed as part of QI?
Today’s health professionals are rightly expected not just to provide exemplary individual care, but to contribute to systematically improving healthcare services, using a process called Quality Improvement (QI).
Despite growing awareness and concern about the climate and ecological emergency, as well as UK Government and NHS England commitments on carbon reduction, sustainability is often seen as separate from clinical and financial priorities. Staff are therefore unsure how to relate this to their practice, while also lacking the time and skills to bring about change. Making sustainability part of QI addresses this gap - empowering staff with the knowledge and tools to address environmental and social challenges in healthcare as a core part of professional practice, using a recognised method for change.
Planning for sustainability is so fundamental to health and to the continuation of care provision that sustainability should be considered an aspect of quality in healthcare. The Royal College of Physicians has identified sustainability as a domain of quality “which must run through and moderate other domains” (safety, timeliness, effectiveness, efficiency, equity and patient-centredness).
Where SusQI comes from
The framework was developed by the Centre for Sustainable Healthcare with partners, including the Royal College of Physicians, and has been shown in research to engage and motivate learners to participate in the sustainable healthcare agenda.
At the Centre for Sustainable Healthcare, we believe that by integrating sustainability into quality improvement, social and environmental challenges in healthcare can be addressed as a core part of professional practice, using a recognised method for change. We are working to make sustainability a part of all Quality Improvement education and practice in healthcare in the UK and internationally.
Find out more
On this website you can:
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Learn about the SusQI Framework
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Apply SusQI using the Step‑by‑Step Guide
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Teach SusQI with the Educator Pack
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Find out about support available to you through The Centre for Sustainable Healthcare's programmes, including The Green Team Competition and SusQI Academy.