A practical way to drive incremental change towards a more ethical and sustainable health system.

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, 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, there remains a gap in knowledge and skills for sustainable healthcare among health professionals.  

Integrating sustainability into quality improvement addresses social and environmental challenges in healthcare as a core part of professional practice, using a recognised method for change. 





Hospital Corridor

How to do a QI project

Group Discussion

 Ideas for QI Educators and Supervisors

Healthcare Worker with Patient

Worked Examples and Implementation 



The Challenge

Here at CSH we acknowledge the strong, academic consensus from the Intergovernmental Panel on Climate Change (IPCC) that if we are going to limit global heating to 1.5°C above pre-industrial levels then unprecedented change is required. We already are experiencing the effects of a 1°C rise. The World Health Organisation (WHO) predicts a rise of 2°C or more will have catastrophic health consequences.


The initial pledges in the Paris Agreement of 2015 to curb greenhouse gas emissions are insufficient to meet the target of limiting global temperature to 1.5 degrees above pre-industrial levels, risking driving the 'Earth systems into a new state'. Every fraction of additional warming above 1.5 degrees will bring worsening impacts, threatening lives, food sources, livelihoods and economies worldwide. At present countries are not on track to fulfil the original promises they made.


In the last 40 years we have emitted dangerous levels of carbon dioxide and seen the extinction of about half of the wild birds, mammals, fish, invertebrates and insects on our planet. If humankind can reduce emissions and prevent a rise in temperatures beyond 1.5°C we may be able to stabilise climate change. Beyond this it is possible that we will move through a number of tipping points and enter a period of warming that will lead to a complete breakdown of the climate as we know it.


Globally, Health Care Without Harm has been leading the global movement for environmentally responsible healthcare for the past 20 years. In 2015 it launched its health care climate challenge and over 200 institutions representing the interests of over 22,000 hospitals have pledged to take meaningful action to reduce healthcare related carbon emissions.


In the UK the beginning of 2020 saw NHS England and NHS Improvement launch the campaign called For a Greener NHS, designed to build on the existing work being done by trusts across the country, sharing ideas on how to reduce the impact on public health and the environment while also saving money.


The NHS employs 1.3 million people and the health and care system in England is responsible for an estimated 4-5% of the country’s carbon footprint. It is estimated that 5% of all road traffic is NHS related. Everyday we see a huge amount of waste being produced but it is often less visible ways in which clinical practice contributes to global heating such as through release of anaesthetic gases or propellants from metered dose inhalers.  


Positively, the NHS is the first health system in the world to set a target for net zero carbon emissions and it is going to require a massive transformation for us to reach this. The SusQI framework links carbon reduction to the core mission of providing the best possible care, and provides you with tools with which to achieve changes on the ground, which cumulatively help to transform the health system.

Pack of Fish

“An understanding of the natural world and what’s in it is a source of not only a great curiosity but great fulfilment.”

Sir David Attenborough



The Centre for Sustainable Healthcare, 
Cranbrook House, 
287-291 Banbury Road, 
Oxford, OX2 7JQ, UK

+44 (0)1865 515811

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