The Institute of Medicine’s Crossing the Quality Chasm defines quality through six widely used domains: safety, effectiveness, patient-centredness, efficiency, timeliness, and equity. Increasingly, the health impacts of climate change (and the health sector’s contributions to climate change and other forms of environmental degradation) are being recognized as directly relevant to these domains. Pollution and climate-related risks increase disease burden, compromise patient safety, and disproportionately affect marginalized populations.
These connections highlight the interdependence of environmental health and healthcare quality. As climate change places growing pressure on populations, ecosystems, and health system infrastructure, integrating sustainability into quality improvement offers a pathway to support more resilient, efficient, and sustainable models of care.
As depicted in the graphic below, there are several features of and developments in quality improvement that render it a particularly powerful driver for sustainability and climate action. These attributes, as well as the SE-QI Framework, are explored in CASCADES’ Sustainability-Embedded Quality Improvement Playbook.
Sustainability-Embedded Quality Improvement (SE-QI) positions quality improvement (QI) as a practical pathway for embedding sustainability within clinical and operational practice. At its core, this approach (which draws from and adapts the Centre for Sustainable Healthcare’s SusQI model) is grounded in the premise that sustainability is inseparable from high-quality care: healthcare systems cannot achieve high-quality outcomes if care contributes to environmental harm that ultimately undermines population health and resilience. In this context, many improvement efforts already generate environmental co-benefits, while sustainability-focused initiatives can reinforce quality outcomes.
Integrating sustainability as a component of health-system quality:
- Strengthens resilience and continuity of care
- Stewards resources for more fair and efficient allocation
- Supports equity by reducing disproportionate impacts
- Protects health for current and future generations
The Collaborative Centre supports several initiatives that seek to embed sustainability into QI frameworks, projects, and reporting.
SE-QI Toolkit
The Sustainability-Embedded Quality Improvement (SE-QI) Toolkit, developed through a collaboration between CASCADES, Health Quality BC, Vancouver Coastal Health, and Interior Health, can be applied to any QI project. Using a Google Form, Individuals or teams provide information about the aims and scope of a planned, current, or past project, and receive curated reports that detail links to sustainability and resilience and suggest relevant resources and environmental metrics. This information can be used to incorporate environmental sustainability into projects; the Toolkit can also be used for training and granting purposes. Individuals, teams, and programs using the SE-QI Toolkit are featured in CASCADES’ SE-QI Spotlight Gallery.
SE-QI Working Group of the Pan-Canadian Network
CASCADES’ Pan-Canadian Network on Health System Response to Climate Change brings together health leaders, planetary health experts, and researchers to support collaborative exchange across the country in service of strengthening organizational capacity for change.
Designated representatives from collaborating organizations functioning as the operational arm of the Practice Network, advancing specific shared opportunities through coordinated action. The SE-QI Working Group supports implementation of the SE-QI Toolkit in projects and training across partnering sites.
SQUIRE-ENV Extension
The Standards for Quality Improvement Reporting Excellence (SQuIRE) guidelines are the international writing guidelines for quality improvement publications. The guidelines provide a framework for reporting new knowledge about how to improve healthcare.
Several extensions to SQUIRE have been developed to provide guidance on particular areas of focus. In this vein, CASCADES is partnering with CQUIPS to develop the SQUIRE-ENV extension, which will clarify reporting for quality improvement projects that include sustainability as a primary or secondary consideration (anticipated publication: spring 2027).
CASCADES Resources
In addition to the SE-QI Toolkit, CASCADES has several other resources that can be used to mobilize QI as a driver for climate action and sustainability, including the QI charter templates embedded in the Sustainable Perioperative Care Playbook, the general QI Project Charter Template, and the Internal Medicine Project Charter for Planetary Health Rounds and supporting resources.
Look for additional QI resources and examples throughout CASCADES’ many resources.