Quality Improvement Zone

Stages of the QI Journey

Things you can do

Identify a core leadership group to set a clear vision related to the climate and sustainability agenda 

Promote sustainability as a domain of quality 

Share the NHSScotland Climate and Emergency and Sustainability Strategy 

Promote and practice value-based health and care 

Establish an improvement team with links to local sustainability champions 

Use process maps  to identify opportunities to improve the outcomes for people and populations at the lowest environmental, social and economic cost (the triple bottom line). When looking for opportunities to reduce the environmental cost, think about the 4 principles of sustainability which are:
   1. Prevention
   2. Patient self-care (in health and social care)
   3. Lean service delivery
   4. Low carbon alternatives

Example: SusQI process map example on catheter usage

Use fishbone diagrams to explore potential causes within the system regarding impact on the environment

Example: ScotGEM fishbone diagram on inhalers

Use Pareto charts to identify areas with largest impact on climate and sustainability (e.g. carbon footprint, waste generation)

Example:ScotGEM pareto chart on bin waste

Develop an aim statement focussed on environmental issues with a clear how much by when, where and for who

Aim statements from ScIL and ScotGEM

Identify primary / secondary drivers within the change theory related to sustainability (e.g. prevention, “lean” systems and pathways, low carbon alternatives, self-care/empowerment)

Example:SusQI Driver Diagram (adapted)

Identify change ideas you can test to reduce the environmental impact of activities/services

Identify change ideas you can test to ensure sustainable value (consider resource use: environmental, financial and people)

Prioritise change ideas that are likely to have the highest impact on health, environmental, social factors and that are most feasible to test.

Create or update work practice standards to outline changes/new ways of working shown through testing to reduce carbon emissions – to make this business as usual

Support staff and services users through communication and/or training regarding the new ways of working

Continue to report and review key measures related to environmental impact and value to ensure improvements are sustained

Use the Spread Planner to support alignment between the sustainability related improvement and the strategic context within the areas/organisations you are looking to spread to.

Consider from the outset, how to spread a change idea when it has been successfully tested, implemented and sustained under a variety of conditions.

Include measures related to resource use (environmental, financial or social) for any intended positive impact as part of the improvement work (e.g. carbon footprint, cost, staff time, service user confidence)

Include balancing measures to monitor the impact of a change in terms of the environment, finance or use of social resource (to monitor and ensure the change is not having a negative impact)

Identify a core leadership group to set a clear vision related to the climate and sustainability agenda (see Create the Conditions)

Establish ways of working and facilitate dialogue with teams to consider climate and sustainability as core business and a shared responsibility

Use the project charter to identify what dimensions of quality the improvement initiative aligns with (including sustainability)

Consider within the rationale of the project charter the potential impact the project will have on resources (environmental, financial and people)