Table 2.

Building sustainability into quality improvement (‘SusQI’): intended benefits

QI element	Sustainability content	Intended benefits
1 Setting goals	Sustainability as a domain of quality; relationship to other domains	New motivation to contribute to QI, energy for change
2 Studying the system	Understanding environmental and social resource use / impacts; carbon hotspots in the NHS; ‘seven capitals’ matrix	Highlights wastes and opportunities which are often overlooked; stimulates radical thinking
3 Designing the improvement effort	The Centre for Sustainable Healthcare principles of sustainable clinical practice (prevention, patient empowerment and self-care, lean systems, low carbon alternatives)a – drivers and process changes	Directs towards highest value improvements, future proofing
4 Measuring impact / return on investment	Triple bottom line / sustainable value equation; measuring carbon	Drives sustainable change; allows benefits to be communicated to broader audience, not exclusively regarding financial cost-benefit

^aFrom Mortimer et al, 2010.¹² QI = quality improvement