The next step in SusQI process is to design the improvement effort by designing and testing ‘change ideas’. The combination of changes made is called the ‘improvement effort’.  To ensure all solutions for sustainable healthcare have been considered it is helpful to consider the Principles of Sustainable Healthcare. 


The Centre for Sustainable Healthcare has defined four principles of sustainable clinical practice:

1. Prevention - promoting health by tackling the causes of illnesses and inequalities 

2. Patient self-care - empowering patients to take a greater role in managing their health

3. Lean service delivery - streamlining care systems to minimise wasteful activities

4. Low carbon alternatives – prioritising treatments with a lower environmental impact

(…and a fifth, less clinical one):

5. Efficient operational resource use - improving use of energy, transport, water, waste, equipment


These can also be viewed in the format of a driver diagram where our outcome is to reduce carbon without reducing health outcomes. 

Driver diagram.png

You can use these principles to help you think through possible strategies for your QI project. Also have a look at the example driver diagrams to see how they have been applied to different areas of practice such as anaesthetics, renal services, diabetes services or intensive care units.

We also have a blank version of the driver diagram for you to try out in designing your own project. There are further examples of how this has been applied in our case studies section. 

Once you have brainstormed and organised as many actions as you can, get your team to help prioritise the top few actions based on their feasibility and impact. If you would like to discuss your ideas you can join one our Sustainable Healthcare Networks or contact us.