Whether organisations are looking to prevent disease, reduce hospital visits for patients with long-term conditions or to tackle local health inequalities, Aarti Bansal from Greener Practice, and Q members Frances Mortimer from the Centre for Sustainable Healthcare and Katy Morris from Midlands Partnership NHS Foundation Trust see the enabling potential of including sustainability as part of quality improvement.
‘Good quality clinical care and sustainability are so, so aligned,’ Aarti Bansal says.
Her organisation, Greener Practice, is a network of primary care professionals encouraging action on sustainability. She sees a huge potential for actions in primary care to reduce carbon emissions across the NHS, while improving patient outcomes.
We can transform care for patients whilst reducing the carbon footprint of care.
‘GPs are the clinical activity gatekeepers. We feed into what happens in acute care and in social care. If we can invest resource in prevention, patient empowerment, efficient patient pathways and better prescribing, we can transform care for patients whilst reducing the carbon footprint of care.’
Katy Morris, Associate Director of Continuous Improvement & Sustainability at Midlands Partnership NHS Foundation Trust, says the trust is just at the beginning of its journey on sustainability but incorporating it into their QI approach using the Centre for Sustainable Healthcare’s SusQI model is already having an impact.
‘The two things just go hand-in-hand. The carbon footprint of the patient journey, time spent in hospital…When we think about how we do QI, we look at our current process and ask, “how can we improve the patient experience, save time and resources”, and now we also ask “how can we reduce the carbon footprint?”’ Morris said.
‘It’s really the beginning for us. Our QI Team and Green Team have been trained in SusQI and Carbon Literacy. We mentor clinical colleagues who are doing QI projects and ask if people want to have a go at SusQI, using the tools.’
Bringing together sustainability and QI with SusQI
Frances Mortimer, Medical Director at the Centre for Sustainable Healthcare, is behind the tools Morris mentions. She wanted to take sustainability beyond the domain of estates, facilities and procurement and into the clinical work at the heart of NHS activities.
‘I really welcomed the fact that people were being taught quality improvement and that people’s responsibilities were being broadened to recognise that they had responsibility for making the system work,’ she explained.
‘So we thought, this is really where sustainability should sit because this is where clinical staff are looking at making the system work.’
Prevention was one of the most powerful ways to reduce emissions, as well as being better for patients.
She introduced a simple approach for incorporating sustainability into mainstream quality improvement methodologies – the SusQI framework – which outlines four stages of the quality improvement process at which to consider sustainability:
- goal setting
- studying the system
- designing the improvement effort
- measuring impact.
Mortimer, Bansal and Morris were clear that prevention was one of the most powerful ways to reduce emissions, as well as being better for patients.
‘It’s the first of the principles of sustainable clinical practice,’ Mortimer said. ‘Whatever condition you’re looking after, it’s part of your remit to think upstream about what’s making people ill. We need to help clinicians think about prevention at a population level but we also need to make it quite practical within somebody’s existing role. Sustainability is a helpful way of introducing more a preventative approach in patient care.’
Morris says, ‘We have applied to be a SusQI Beacon Site with the Centre for Sustainable Healthcare – they’ll be coaching us through it. We’ll share our current training, case studies and the feedback we’ll get from them will give us the confidence we need. We also get to be part of the SusQI Academy which means we can connect with other organisations. The brilliant thing is it all fits so well with our current QI academy, we just need to enhance our sustainability resources, which are available on the CSH website. It’s there ready to go.’
Tackling health inequalities
The first project that Greener Practice developed with the support of The Health Foundation was developing a QI resource to improve the quality of asthma care whilst also reducing the carbon footprint from inhalers.
The toolkit went through a quality assurance process through the NHSE&I Inhalers Working Group and the resulting Asthma toolkit is a step-by-step guide for UK general practices to implement high quality and low carbon asthma care.
Those who did the least to contribute have disproportionately less access to green space, clean air, warm homes – the health impact is disproportionate.
Bansal is excited at the potential for sustainability efforts to focus on reducing health inequalities through prevention and patient empowerment.
‘One thing I’ve been thinking a lot about is that those who did the least to contribute have disproportionately less access to green space, clean air, warm homes – the health impact is disproportionate,’ she explained.
‘If we can focus the case on those who need it most then that’s the inherently sustainable thing to do. Tackling inequalities empowers care for all of us…All the things we want to do to make health care more sustainable are things we should being doing anyway for patients. If we make healthcare more sustainable, we will benefit from those health gains now.’
Digital solutions
Morris sees digital as both a consideration and an enabler for SusQI. For example, remote consultations, which became a necessity during COVID-19, can be better for patients and the NHS carbon footprint.
They were naturally taking ideas and projects from sustainability into digital and the other way around.
However, both Morris and Bansal were clear it always needs to come down to what’s best for the patient. Bansal pointed out that in some cases one physical consultation, rather than several remote ones, can save time and additional treatment, which is better for patients and planet overall.
‘A lot of projects for the green plan are digitally enabled,’ Morris says. ‘In the organisation we have a Clinical and Practice Network, including digital champions who are clinicians, and sustainability champions. We encourage project sharing across groups. We found they were naturally taking ideas and projects from sustainability into digital and the other way around.’
Empowering the future clinical workforce
Embedding SusQI across the NHS involves both supporting teams in the workplace and incorporating it into clinical education. The Centre for Sustainable Healthcare is working with early movers in this area, both through supporting beacon sites and through their SusQI Academy.
Through funding from the Health Foundation, Health Education England and Kings College London they have been able to work with education programmes for different health professionals from nurses and foundation doctors to paramedics and allied health professionals.
‘We didn’t want to limit the opportunity for organisations to become beacon sites to only those who join the Academy because if they want to do things in a different way, that’s fine. Through the beacon sites and the Academy we’re hoping to go on the SusQI journey with people and learn about it as we go,’ Mortimer says.
Their work in clinical education is empowering students and staff to tackle sustainability challenges through quality improvement practices and it’s been incredibly well received.
‘There’s a whole generation who are absolutely terrified by climate change and they feel really powerless and actually what we need to do now is not just tell them how bad it is or even tell them what needs to change but to help them be part of changing it.’
Join our Sustainable Healthcare Special Interest Group to share your success stories and connect with colleagues on SusQI, sustainability and quality improvement.
Resources
Centre for Sustainable Healthcare SusQI toolkits and resources: https://www.susqi.org
NHS England Greener NHS: https://www.england.nhs.uk/greenernhs
Greener Practice: https://www.greenerpractice.co.uk