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. 2025 Jun 8;14(2):e003055.
doi: 10.1136/bmjoq-2024-003055.

Strategies for implementing Sustainability in Quality Improvement (SusQI) education: educator perspectives

Victoria Stanford  1 , Kathleen Leedham-Green  2   3 , Alice Clack  2 , Siobhan Parslow-Williams  2 , Ayoma Ratnappuli  2 , Frances Mortimer  2
Affiliations

Strategies for implementing Sustainability in Quality Improvement (SusQI) education: educator perspectives

Victoria Stanford et al. BMJ Open Qual. .

Abstract

The climate and ecological emergencies represent a significant threat to health, and yet healthcare is a major contributor to environmental degradation. Sustainability in Quality Improvement (SusQI) is a framework that enables healthcare professionals to improve how good health is achieved and healthcare delivered in line with social, economic and environmental sustainability goals. SusQI education provides healthcare learners with the knowledge and practical skills for sustainable clinical transformation.We interviewed 11 SusQI course leads at 10 educational sites in the UK and Ireland, exploring educator perspectives on how SusQI can be successfully implemented in diverse health educational contexts. Our aim was to identify what works, in which contexts and why. We thematically analysed the interviews and tabulated case study details.We identified four interlinked themes: choosing SusQI, getting it into the curriculum, making it work and embedding it. Each of these stages was influenced by factors related to the educators themselves, their students and their institution, as well as specific educational or curricular factors. The most successful implementations demonstrated synergistic benefits for both learners and institutions, engendering self-sustaining communities of practice.Strong institutional commitment, distributed expertise and opportunities for supported project work emerge as key success factors. Together, these fostered self-sustaining virtuous cycles of stakeholder engagement, transformative educational impacts and progress towards sustainable clinical practice.

Keywords: Medical education; Qualitative research; Quality improvement; Quality improvement methodologies.

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Conflict of interest statement

Competing interests: VS, AC and AR completed this work as Education Fellows at the Centre for Sustainable Healthcare for which they received a salary. SP-W and FM are paid staff at the Centre for Sustainable Healthcare. SP-W is the SusQI Education and Evaluation Lead and FM is Medical Director. KL-G is a Senior Education Fellow at Imperial College London and committee member at CSH.

Figures

Figure 1
Figure 1. The principles of sustainable healthcare. Adapted from Mortimer.
Figure 2
Figure 2. Key steps in SusQI implementation with positive feedback loops. SusQI, Sustainability in Quality Improvement.
See this image and copyright information in PMC

References

    1. A Commission on climate change. The Lancet. 2009;373:1659. doi: 10.1016/S0140-6736(09)60922-3. - DOI - PubMed
    1. Drew J, Christie SD, Rainham D, et al. HealthcareLCA: an open-access living database of health-care environmental impact assessments. Lancet Planet Health. 2022;6:e1000–12. doi: 10.1016/S2542-5196(22)00257-1. - DOI - PubMed
    1. NHS England and NHS Improvement Delivering a ‘net zero’ national health service. 2020
    1. GMC Good medical practice. 2013
    1. GMC Outcomes for graduates 2018. https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-... n.d. Available.

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