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What is SusQI?

Sustainability in Quality Improvement (SusQI) is an approach to improving healthcare in a holistic way, by assessing quality and value through the lens of a “triple bottom line”.

In SusQI, the health outcomes of a service are measured against its environmental, social and economic costs and impacts to determine its “sustainable value”.  SusQI embeds the CSH principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean clinical pathways and low-carbon alternatives.

Rather than being a replacement for traditional QI, SusQI is designed to embed sustainability into current QI theory and practice, and thus provide practical tools to support health-workers in contributing to health-system transformation.

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.  

“Healthcare should be considered not only in terms of what can be delivered to an individual today, but also to the population in general and the patients of the future.” 

Atkinson S, Ingham J, Cheshire M, Went S. Defining quality and quality improvement. Clinical Medicine. 2010 Dec;10(6):537.

Why is sustainability needed as part of QI? 

Planning for sustainability is so fundamental to health and to the continuation of care provision that sustainability should be considered an aspect of quality in healthcare.The Royal College of Physicians has identified sustainability as a domain of quality “which must run through and moderate other domains” (safety, timeliness, effectiveness, efficiency, equity and patient-centredness). 

In this video, Dr Frances Mortimer, Medical Director at CSH explains further why including sustainbility as part of QI is both necessary, and urgently needed. 



Domains of Quality

The SusQI Framework: how do we go about including sustainability in quality improvement?

Sustainability in QI (or SusQI) recognises that there are finite environmental, social and financial resources available to deliver a high standard of patient care. The overall goal of incorporating sustainability into quality improvement is to maximise sustainable value. This means to deliver the best possible health outcomes with minimum financial and environmental costs, while adding positive social value at every opportunity. As in a standard cost-benefit analysis, the concept can be expressed as an equation, where value = outcomes / costs:

Sus Value eq redrawn 2.jpg

The sustainable value equation is not designed to be solved, or reduced to a single number. It should be used to guide holistic thinking, so that all aspects of the equation are considered in quality improvement projects. 

Including sustainability and resource stewardship into QI allows health professionals to respond to the ethical challenges of climate change and social inequalities. It also benefits the QI process itself: inspiring new energy for change, highlighting waste and opportunities otherwise overlooked, and directing projects systematically towards the highest value improvements.
Find out more about the SusQI approch using our Step-by-Step Guide and see examples of SusQI in practice in Case Studies

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