SusQI
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.” This relationship – outcomes weighed against cost and impact – is what we call the sustainable value equation.
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 Royal College of Physicians has identified sustainability as a domain of quality “which must run through and moderate other domains.”
— Royal College of Physicians, Future Healthcare Journal, 2018
See how the sustainable value equation works on the SusQI website.
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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 – the best possible health outcomes, delivered with minimum financial, environmental and social resources, while adding positive social value at every opportunity.
SusQI achieves this by embedding The Principles of Sustainable Healthcare into the QI process: prevention, patient empowerment and self-care, lean clinical pathways and low-carbon alternatives.
Explore the four principles on the SusQI website.
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.
CSH puts the framework into practice through Green Team Competitions and Specialty Challenges, in which clinical teams apply SusQI to their own quality improvement projects. In 2025, Green Team Competitions applying the SusQI framework delivered £2.7 million+ in financial savings and avoided 689 tonnes of CO₂e across 75 teams.
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.
See more evidence and results on the SusQI website.