Principles of Sustainability in Quality improvement

The SusQI framework outlines four stages of the quality improvement process at which sustainability should be considered and actively implemented.   

This easy to implement step-by-step guide for each stage of the process can be utilised in any healthcare setting.   

Setting goals 

The first part of the SusQI framework involves defining the problem and goal of the process. During this, consideration should be given to environmental and social impacts and a culture of resource stewardship.  

Studying the system  

Before thinking about improvements, it is vital to understand the current system. This can be done through value process maps where environmental, social, and financial resource allocation is identified. This can recognise wasteful or valueless steps and carbon hotspots within a pathway or process which can be addressed through improvement projects.  

Designing the improvement  

When considering changes to address a problem, the principles of sustainable healthcare; prevention, patient empowerment, lean pathways, low carbon alternatives, and sustainable operational resource use, should be considered for application.   

Measuring impact  

As with all QI, a clear set of measures are essential for assessing changes in improvement. SusQI is unique in the consideration of a set of measures within the sustainable value equation (Figure 3). Outcomes are considered and measured for patient and/or population health as in all QI,  with an additional focus on environmental impact measured through a reduction in activity/resources used or through a carbon emissions assessment.  Social impacts for patients, staff and carers should also be measured in addition to assessing financial costs/savings.   

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.