Sustainability-Embedded Quality Improvement 

Summary  / Key takeaways

Climate change and environmental pressures are increasingly disrupting healthcare systems, affecting service delivery, workforce capacity, and patient outcomes. Extreme weather events, supply chain disruptions, and widening health inequities highlight the need to strengthen systems while reducing environmental harm.

Sustainability-Embedded Quality Improvement (SE-QI) positions quality improvement as a practical pathway for embedding sustainability within clinical and operational practice. At its core, this work is grounded in the premise that sustainability is inseparable from high-quality care: healthcare systems cannot achieve high-quality outcomes if care delivery 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.

The SE-QI Framework was developed in collaboration with key partners and experts in QI across Canada. It serves as a resource for clinicians, health care professionals, students, trainees, and decision-makers involved in QI work to advance high-quality, low-carbon, resilient healthcare.

Practical tools support implementation, including an SE-QI Toolkit, Project Charter templates, and SQUIRE-ENV Extension guidance, which help embed sustainability into how QI initiatives are designed, documented, and shared.

Implementation is supported through aligning projects with organizational priorities, connecting teams, embedding sustainability into governance and accountability structures, building capacity, and sustaining successful improvements over time.

Playbook: Sustainability Embedded Quality Improvement (SE-QI)

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Suggested Citation:

Cruz, A, Simms, N, Ritcey, G, MacNeill, A, Miller, F. Sustainability Embedded Quality Improvement (SE-QI). Version 1.0. [Internet]. CASCADES; 2026 [cited DATE]. Available from: https://cascadescanada.ca/.

Tool: Sustainability-Embedded Quality Improvement Toolkit

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SE-QI Spotlights

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Sustainability-Embedded Quality Improvement Toolkit

This toolkit will help individuals and teams incorporate environmental sustainability into quality improvement (QI) initiatives, and envision how you can adjust, measure and report those impacts.

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Tool

Sustainability-Embedded Quality Improvement (SE-QI) Toolkit : Train-the-Trainer

CASCADES

A slide deck introducing the SE-QI framework and toolkit. 

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Slide deck

SusQI Framework

Centre for Sustainable Healthcare

Sustainability in Quality Improvement Sustainability in Quality Improvement (SusQI) is an approach to improving healthcare in a holistic way, by assessing quality and value through the sustainable value lens. In SusQI, the health outcomes of a service are measured against its environmental, social and economic costs and impacts to determine its “sustainable value”.

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Health Quality BC

Our Vision is High-Quality and Sustainable Health Care for All. Every Day, Every Time, for Everyone in British Columbia.

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Squire-ENV Extension

The SQUIRE-ENV extension is being led by the Centre for Quality Improvement and Patient Safety (CQuIPS) in collaboration with CASCADES and national and international quality improvement leaders. Building on the internationally recognized Standards for Quality Improvement Reporting Excellence (SQUIRE), this extension establishes structured guidance for reporting environmental sustainability in quality improvement projects where sustainability is a co-benefit or primary aim. Because SQUIRE is widely used by journals, conferences, and healthcare systems to report improvement work, SQUIRE-ENV will help embed sustainability into how QI initiatives are designed, documented, and shared. Publication is anticipated in 2026.

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