QI and Sustainability

Last year, we asked Dr Peter Wilkinson to write a short blog on his reflections and his top 5 learning points following his participation in a one-week, in-person training course provided by the Institute for Healthcare Improvement (IHI).

As well as being an Improvement Coach, Dr Wilkinson is also an Ambassador for Health and Sustainability for NHS England and he shares our passion for improving sustainability in healthcare.  We asked Peter to share another blog, this time on the subject of quality improvement and sustainability, which will hopefully give you some food for thought.

Please leave your comments in the section below and get in touch if you would like to discuss any ideas in person.

QI and Sustainability

Did you know that the carbon footprint of the NHS in England for 2015 was 22.8 MtCO2e (Million tonnes of CO2 equivalent)?  That sounds like a lot… and it is a lot!

The target for the UK is 2,544 MtCO2e over the third carbon budget period (2018 to 2022) so not surprisingly the NHS, with over 1 million employees and around 1 million patient contacts every 36 hours, is a major contributor to carbon production.

Given the concerns shared by so many people about the impact of global climate change, the quality of our air and disposal of plastic in our environment – health care systems around the world should be leading the way in promoting and living a sustainable lifestyle.


Picture above from ‘Breaking the fever: Sustainability and climate change in the NHS

Where does QI fit into this?

There are a couple of ways that improving quality in healthcare can also contribute to improving sustainability.  Firstly, there are QI projects that specifically aim to improve sustainability by reducing waste, improving efficiency, etc.

A great example of this is the ‘Green Ward’ competition created and supported by the Centre for Sustainable Healthcare (CSH) in Oxford.  Normally sustainability is seen to be the responsibility of an Estates Department in hospitals as they typically manage the buildings, the use of energy and the procurement of everything from medical devices to food.

The Green Ward competition, however, recognises that all staff in the hospital have the potential to contribute to environmental sustainability and the aim of the competition was to inspire QI projects based on sustainability goals and carbon measures, which are created by the clinical teams themselves.

At ASPH we had a number of projects that were initiated as part of the competition.  One project successfully reduced paper consumption by redesigning short stay admission forms; which, in addition to carbon savings, also reduced admin time for nurses enabling them to spend more time with patients.  Another project made significant savings by using patient’s own medication during admission and not duplicating this on discharge and you can see the whole case study here.

Secondly, there is the inclusion of sustainability measures in all quality improvement projects in healthcare.

This paper written by Dr Frances Mortimer, Medical Director of CSH, challenges us to automatically  incorporate measures of sustainability, including environmental and social impacts, in all QI projects.

recent publication by the Royal College of Physicians on how outpatients are managed in secondary care, describes how the number of outpatients has almost doubled in the last decade.

SusQI3Each time a person comes to an outpatient clinic it often involves driving long distances to a hospital adding to poor air quality and traffic congestion.  I have just seen a patient who has been travelling into central London from outer London suburbs annually for 37 years for a check-up that could have been carried out locally.  In addition to the travel, car parks have to be built and clinics have to be constructed with heating and lighting to accommodate these appointments.

The report challenges us to clarify the value of each clinic visit and to see if it can be conducted by other means than traveling to a hospital.  This report provides the basis for multiple QI projects all of which could have sustainability measures attached to them adding credibility to making changes.


Healthcare systems have an ethical obligation to use physical resources in the most sustainable way and therefore should automatically incorporate measures of resource utilisation in all appropriate QI projects.

You can read more from the Royal College of Physicians on the subject in their ‘Breaking the Fever’ report here – https://www.rcplondon.ac.uk/projects/outputs/breaking-fever-sustainability-and-climate-change-nhs


Dr Peter Wilkinson

Consultant Cardiologist

Ambassador for Health and Sustainability (NHS England)



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