Sustainability in Quality Improvement (SusQI): challenges and strategies for translating undergraduate learning into clinical practice

Background The healthcare sector is a major contributor to climate change and there are international calls to mitigate environmental degradation through more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a nationally mandated outcome for all UK graduating doctors who must demonstrate their ability to address social, economic, and environmental challenges. Bristol Medical School piloted successful Sustainability in Quality Improvement (SusQI) workshop, but identified challenges translating classroom learning into clinical practice. This paper aims to identify and address those challenges. Methods We conducted five focus groups that identified and iteratively explored barriers and facilitators to practice among medical students, comparing a range of experiences to generate a conceptual model. We then combined our findings with behaviour change theory to generate educational recommendations. Results Students that applied their learning to the clinical workplace were internally motivated and self-determined but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and practices or frustrated by institutional inertia. These barriers impacted on their confidence in suggesting or achieving change. A minority saw sustainable healthcare as beyond their professional role. Conclusions We present a series of theoretically informed recommendations. These include wider curricular engagement with concepts of sustainable clinical practice; supportive workplace enablement strategies such as workplace champions and co-creation of improvement goals; and time and headspace for students to engage through structured opportunities for credit-bearing project work.

Automated summary

The healthcare sector is a major contributor to climate change and there are international calls for more sustainable forms of clinical care. The UK healthcare sector has committed to net zero carbon by 2040 and sustainable healthcare is a mandated outcome for all UK graduating doctors. Bristol Medical School piloted the Sustainability in Quality Improvement (SusQI) workshop and identified challenges in translating classroom learning into clinical practice. The study conducted focus groups to identify barriers and facilitators to practice among medical students, and generated educational recommendations based on the findings and behavior change theory. Students who applied their learning to the clinical workplace were internally motivated and self-determined, but needed time and opportunity to complete projects. Other students were cautious of disrupting established hierarchies and frustrated by institutional inertia, impacting their confidence in suggesting or achieving change. Conclusions include recommendations for wider curricular engagement with sustainable clinical practice, workplace enablement strategies, and structured opportunities for project work.