Sustainability in quality improvement: the time has come!

Wednesday, 6 June, 2018

Health systems are in constant need of improvement - and in some cases total redesign. Populations are ageing and changing, technologies continue to evolve and expand and meanwhile, services are creaking as they hang on to structures and processes inherited from an earlier time. 

Today’s health professionals are rightly expected not just to provide exemplary individual care, but to contribute to systematically improving the services within which that care is delivered. 

But what a waste if you work hard to improve a system and yet fail to notice that it relies on environmental and social resources that cannot be counted with a £ sign! You may optimise individual steps in a pathway but miss opportunities to promote wellbeing, reduce healthcare demand, empower patients or prevent ecological damage. 

The Royal College of Physicians has recognised sustainability as a domain of quality in healthcare and has said that ‘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.’ I agree. And it seems to me that if sustainability is part of quality, then it should also be an integral part of quality improvement, or QI.

In 2 papers [1,2] published in the Future Healthcare Journal this week, my co-authors and i put forward a simple approach for incorporating sustainability into mainstream QI methodologies, which we have called the ‘SusQI’ framework. This is supported by a set of open access learning resources which you can find here.

We believe that including sustainability and resource stewardship in QI provides a practical way for health professionals to respond to ethical challenges such as climate change and social inequalities. But we have also found that it can bring immediate benefits to the QI process itself, including new motivation and energy for change, highlighting wastes and opportunities otherwise overlooked, and directing projects systematically towards the highest value improvements.

If you are involved in teaching, leading or contributing to quality improvement, please have a look at the SusQI framework and think whether you could apply it within your work.

Dr. Frances Mortimer
Medical Director, Centre for Sustainable Healthcare 


  1. Sustainability in quality improvement: redefining value.  Mortimer F, Isherwood J, Wilkinson A, Vaux E. Future Healthcare Journal, 2018 Vol.5(2):88-93
  2. Sustainability in quality improvement: measuring impact.  Mortimer F, Isherwood J, Pearce M, Kenward C, Vaux E. Future Healthcare Journal, 2018 Vol.5(2):94-97