What is SusQI?

Quality Improvement (QI) in healthcare is a standard approach to learning, development, and improvement for all healthcare staff that applies small changes to pathways and procedures to improve quality of care and patient outcomes, but how can sustainability be a part of that? What is the difference between traditional quality improvement and sustainable quality improvement?

What is sustainability in quality improvement (SusQI)?

Sustainability in Quality Improvement (SusQI) is an approach to improving healthcare in a holistic way, by assessing quality and value through the lens of environmental and social sustainability.

In SusQI, the health outcomes of a service are measured against its environmental, social and economic costs and impacts to determine its ‘sustainable value’.  SusQI embeds the CSH principles of sustainable healthcare: prevention, patient empowerment and self-care, lean clinical pathways, low-carbon alternatives, and sustainable operational resource use.

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 health workers in contributing to ethical and sustainable health system change.

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.

Why is sustainability needed as part of quality improvement? 

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). 

How do we include sustainability in quality improvement?

Sustainability in QI (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 and environmental costs, while adding positive social value at every opportunity. 

As in a standard cost-benefit analysis, the concept can be expressed as an equation, where value = outcomes / costs:

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. 
 
Including sustainability and resource stewardship in 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.