Sustainability in quality improvement: redefining value

Abstract

Sustainability can be considered a domain of quality in healthcare, extending the responsibility of health services to patients not just of today but of the future. The longer term perspective highlights the impacts of our healthcare system on our environment and communities and in turn back onto population health. A sustainable approach will therefore expand the healthcare defi nition of value to measure health outcomes against environmental and social impacts alongside fi nancial costs. We set out a practical framework for including these new dimensions in an already well-defi ned model of quality improvement. This has the potential to harness the growing quality improvement movement to shape a more sustainable health service, while improving patient outcomes. Early experience suggests that the new model may also provide immediate benefi ts, including additional motivation for clinicians to engage in quality improvement, directing their efforts towards high value interventions and enabling capture and communication of a wider range of impacts on patients, staff and communities.

A new role for anaesthetists in environmentally‐sustainable healthcare

“…Our experience suggests that confining sustainability teaching within ethics or global/public health curricula limits its incorporation into routine clinical practice. Instead, we contend that sustainability principles should be integrated across teaching domains, including clinical teaching and quality improvement . For example, anaesthetists might teach students about how TIVA and regional anaesthesia can not only improve patient outcomes when used appropriately but can also reduce the environmental impact and financial cost of anaesthesia when compared with using inhalational agents .…”

“…This definition is not explicitly environmental, but environmental sustainability is one key factor that must be reconciled together with the social demands and economic constraints of healthcare. Organisations such as the Sustainable Development Unit and the Centre for Sustainable Healthcare make this explicit by considering the costs and impacts of environmental sustainability as part of the ‘triple bottom line’ of social, environmental and financial accountability (‘people, planet, public purse’) .…”

Health and sustainability

“…Mortimer et al, in two related articles, describe how sustainability can be incorporated into quality improvement methodology as a meaure of value. 7,8 The idea of sustainability as a concept of value is then taken further by de Preux and Rizmie who succinctly demonstrate how environmentally (less carbon intensive) practices can also be economically favourable and should be considered during the evaluation of potential care pathways. 9 Finally, Dunbar-Rees 10 describes different funding models and how current activitybased commissioning can offer perverse incentives and barriers to patient-centred change.…”

Better quality of care equals better carbon footprint?

“…Delivering a high-quality healthcare service can translate to improved carbon footprint,2 for example, by reducing inappropriate investigations, hospital stays and improving health outcome. Procurement of pharmaceuticals, devices, goods and services is one of the highest contributors to carbon footprint in healthcare 3.…”