7 February 2024

Using Quality Improvement to tackle environmental sustainability

By Sarah McAllister – Senior Improvement Advisor  

East London NHS Foundation Trust (ELFT) aims to reduce direct greenhouse gas emissions by 40% by 2025 and indirect emissions by 40% by 2036.  This ambitious aim is being supported through a programme of work that uses quality improvement (QI) methods to understand our problem, develop a change strategy, test change ideas and implement ideas that are shown to work. 

To understand where our biggest greenhouse gas (GHG) emissions were coming from, we created a Pareto chart.  This helped us identify the key areas we should focus our attention on.  Figure 1 shows where our biggest emissions are coming from. 

Figure 1 – ELFT’s emissions profile  

Working with our key stakeholders – service users, carers, communities, staff, and partners – we developed a change theory and programme level measurement plan around six workstreams: 

  1. Estates and Facilities
  2. Medicines 
  3. Leadership and workforce 
  4. Travel and transport 
  5. Sustainable models of care 
  6. Procurement 



Figure 2 – example of change theory for our medicines workstream 

Figure 3 – our programme’s overarching outcome measures  

There are currently 77 active QI projects that have overt links to our sustainability goals.  These projects have their own local measures, however feed into the overarching aims of the Green Plan.  Some examples of local work that’s happening within our six workstreams are as follows: 

The Luton Crisis team aimed to reduce medication waste by 25% by June 2023.  Since beginning the work, they have gone from destroying 119 tablets bi-weekly, to destroying just 4.4 tablets bi-weekly.  Find the full story here. 

Figure 4 – I chart showing number of tablets destroyed bi-weekly

The Newham Musculoskeletal physiotherapy service aimed to increase the number of walking aids returned per week.  Since beginning the work in June 2023, they went from an average of 0 walking aids returned per week, to an average of 5.2 walking aids returned per week.  Check back soon to see a film detailing the team’s project and successful change ideas. 

Since beginning the programme in June 2021, we have also seen reductions on our programme level measures.  Notably, we have reduced our gas consumption by 37% in the winter months (Figure 5). 

Figure 5 – Gas consumption in the winter months 

For those wanting to know more detail about our environmental sustainability work, an in-depth report of the work is currently being written up and will be published in an academic journal later this year. 


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