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Is the change an improvement?

Measurement is a vital aspect of testing and implementing changes; measures tell a team whether the changes they are making actually lead to improvement.

The SusQI encourages a holistic approach to assessing the impact of your improvement. The sustainable value equation below is used to conceptualise the aspects which contribute to sustainable value. The idea is not to solve the equation, or to deduce it to a singe figure-it should be used to guide your thinking as you consider each aspect in turn.


Most QI projects focus on patient outcomes or financial impacts. These are often quantitative measurements.  In this section we focus on ways in which environmental outcomes (including calculating a carbon footprint) and social outcomes can be measured. The financial and patients and population impact are not covered in depth as they are not unique to the SusQI approach, however we do give some pointers on these areas to get you started.

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Patient outcomes

The relevant patient outcomes will depend on your specific patient pathway or service. 

Why not measure your outcomes based on agreed upon standards of care eg. national or hospital targets and protocols? 

Or you could measure how your improvement matches up to patient-identified goals and preferences? This could ensure what you are measuing is what matters most to patients. 

Remember: your changes could produce negative outcomes too. Think about how to identify this, eg. monitoring incident reporting. These are referred to as 'balancing measures' as they measure unintended consequences of change.


Nurse and Patient

Population outcomes

Considering population outcomes in SusQI is closely related to another domain of quality in healthcare; equity. This is about making sure that people receive the care they need irrespective of their socio-economic characteristics.  We should also consider the impacts of a service on different groups of people.


You may be able to put the figures into context using population level data for the patient group you are working with – this could be taken from your local Joint Strategic Needs Assessment (JSNA) or from Public Health England Fingertips, which are both freely available online. Where local data is not available, national data can sometimes be used, adjusted for local populations. 



Environmental outcomes: carbon footprinting

 Though we have an estimate of the NHS’s carbon footprint overall, the carbon impact of quality improvement projects is not usually routinely measured.


In order for the NHS to reduce its greenhouse gas emissions to net zero by 2050, carbon needs to become an additional currency alongside money, understood by all working in the health system.

This video will give you a short introduction to carbon footprinting. It is likely this is a topic that is unfamiliar to  you as a healthcare professional. We at CSH have designed this document to enable you to calculate the carbon emissions and carbon savings associated with your specific project.

If you would like to know more about this topic, take a look at our Carbon Footprinting for Healthcare course here

Social Outcomes

The aim of SusQI is to improve the outcomes for patients and populations with minimal financial costs and harmful environmental impacts while adding social value at every opportunity.


Health services can influence the social circumstances of patients, carers, dependants, staff, local and distant communities (e.g. people working in the supply chain). 

There is no single way to understand social outcomes, and we encourage you to think broadly. This scanning for social impacts table is designed to give you a structured approach to considering the most important positive and social impacts on those most impacted by your improvement. 

This video provides insight into the human cost of the manufacturing system which provides NHS surgical instruments. Could your project address similar social injustices?

Financial Outcomes

By speaking to those involved in procurement, you may be able to find out the actual costs to your service of things like energy use, waste disposal or buying equipment.

If this is not possible, then you may have to extrapolate from national data, e.g. the British National Formulary for pharmaceuticals, or PSSRU Unit Costs of Health and Social Care for units of healthcare activity / staff time. Remember to look for indirect costs or savings that occur from knock-on effects of your project, as well as the direct changes.

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