Evidence for SusQI comes from multiple sources, including peer‑reviewed research, real‑world improvement projects, education and training programmes, and system‑level adoption. Together, this growing evidence base shows how SusQI works in practice and why it is effective in transforming care.​

 

Peer‑reviewed research and academic evidence​​

• The SusQI Framework: Mortimer et al.

  • Sets out the SusQI Framework in detail, including its conceptual foundations and application to quality improvement.

• The Principles of Sustainable Healthcare: Mortimer.

  • Describes the Centre for Sustainable Healthcare’s core principles linking sustainability, quality and outcomes.

• SusQI: measuring impact: Mortimer et al.

  • Uses case studies to explore how different dimensions of sustainable value can be measured in practice.

• Teaching skills for sustainable healthcare: Stanford et al.

  • Demonstrates the value of the SusQI framework for engaging health workers in system transformation.

• Strategies for implementing SusQI education: educator perspectives:

  • Presents insights from course leads on implementing SusQI across a range of health education settings.

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Evaluation of SusQI resources and programmes

• Concrete ways we can make a difference: Spooner et al.

  • Evaluates trainee experiences of SusQI, Finding SusQI increased motivation to engage in sustainable healthcare and quality improvement generally.

• Implementing Sustainable Healthcare Projects in the NHS: A Qualitative Evaluation of the 2022 Green Team Competition: Shaw, Roach and Ferry.

  • ​Read the pre‑print report from an evaluation led by the University of Oxford.

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SusQI in action - Case studies

​​CSH hosts over 200 SusQI case studies within the Sustainable Healthcare Networks resource library, showcasing how health professionals, teams and organisations are using SusQI across a wide range of healthcare settings. These case studies document how clinical, environmental, social and financial sustainability has been incorporated into quality improvement projects.

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Explore the SusQI case library here. ​

 

Case study spotlights:

• Clinical team: reducing impact of nausea and vomiting in pregnancy:

  • Demonstrates how SusQI projects can improve safety, quality, equity and resource-efficiency of care while benefiting patients and staff. 

• Healthcare delivery organisations: 

  • ​Case Studies from Two NHS Trusts on Embedding Sustainability into QI Training & Practice.

• Academic organisations:

  • ​Presentations from 4 education settings on how sustainability is being/has been integrated into quality improvement education.

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SusQI in action - System level adoption and influence

SusQI is designed to integrate into existing quality improvement methodologies, training programmes and governance structures, supporting sustainability to become part of routine practice rather than a separate or additional agenda. ​Evidence of this system‑level integration includes its direct adoption, formal alignment, and wider influence across education bodies, training programmes, professional standards, improvement organisations, and health‑system policy and governance.

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• International standards, improvement guidance and reporting 

  • ISQua Green Paper: 

    • ​CSH has supported the International Society for Quality in Healthcare in advocating for sustainable healthcare, embedding sustainability into guidelines and developing training resources. SusQI is identified as Action 1 of 8 within ISQua’s practical actions pathway.

  • SQUIRE environmental sustainability guideline extension:

    • In 2025–26, CSH is collaborating with the University of Toronto’s Centre for Quality Improvement and Patient Safety (CQuIPS) and CASCADES to develop an environmental sustainability extension to the SQUIRE reporting guidelines.

• Education, training and workforce development

  • E-learning for healthcare (e-LfH) sustainability modules: 

    • Five sustainability modules co‑developed with CSH, covering net zero, sustainable quality improvement, endoscopy, operating theatres and dentistry.

  • The UK Foundation Programme:

    • Sustainability and quality improvement resources aligned with curriculum requirements, including SusQI webinars and case studies.​

• Professional forums and communities of practice​

  • IHI International Quality and Safety Forum (London, 2024): 

    • ​CSH contributed as a programme advisor, supporting the integration of sustainability within global quality and safety conversations.

  • Q Community: 

    • ​The SusQI team are members of the NHS Confederation (previously Health Foundation) Q community, promoting sustainable healthcare principles, facilitating shared learning, and previously convening the Sustainable Healthcare Special Interest Group and hosting Q Visits to showcase practical application of SusQI.

• Health system implementation, policy and oversight

  • Green Plan Guidance, NHS England:

    • Completing quality improvement projects in clinical areas that focus on a reduction in emissions, with co-benefits for outcomes and quality of care, efficiency and reducing healthcare inequalities is recommended in the 2025 guidance.

  • Health Education and Improvement Wales (HEIW):

    • HEIW is implementation a Climate Smart Education and Training Action Plan including embedding sustainability in quality improvement education, supporting healthcare professionals to deliver sustainable, high‑quality care across NHS Wales.

  • NHS Education Scotland: 

    • In this presentation from the 2023 SusQI Showcase, David Maxwell, Professional lead at NHS Education for Scotland, shares how sustainability was incorporated into quality improvement education in NHS Scotland.