How can we embed sustainable quality improvement at Cardiff and Vale UHB?

How can we embed sustainable quality improvement at Cardiff and Vale UHB? 

At Cardiff and Vale University Health Board (UHB), sustainability is a priority in ensuring we can continue to deliver healthcare outcomes that matter today and in the future. In the ‘Shaping Out Future Wellbeing Strategy 2023-2033', it is one of the key objectives under the headline ‘Acting for the future’. 

As a public body, the Health Board is legally obliged to ‘act in a manner which seeks to ensure that the needs of the present are met without compromising the ability of future generations to meet their own needs.’  

Following Welsh Government, the Health Board declared a climate emergency in 2020 and we still have much to do to reduce our carbon footprint – like many large healthcare organisations, we are a big contributor to greenhouse gas emissions, and we prioritise action that will enable us to meet the targets for decarbonisation. We also need to ensure that we remain at the forefront of advances in health care partnerships. With the right leadership, investment and research support from partners, the Health Board is in a unique position in Wales - working with our local universities, the life sciences and independent sector - to develop and adopt modern diagnostic and treatment technologies that will enable us to transform the way we are able to diagnose, treat and support patients. 

So, what does sustainable quality improvement look like in practice? 

Well, there are many actions under the sustainability agenda within CAV UHB such as: 

• Be the exemplar organisation in NHS Wales for delivering our carbon emissions targets and fully supporting active and sustainable travel for staff and visitors to patients.  
• Promote and use digital technology to support remote working, virtual clinics and virtual wards reducing the need for patients and staff to travel unnecessarily (where appropriate). 
• Promote, reward and embed successful waste reduction as part of our quality programme of continuous improvement. 

Alongside this, Shaping Change recently became an Aspiring Beacon site with the Centre for Sustainable Healthcare. 

Sustainable Quality Improvement (SusQI) recognises that there are finite environmental, social and financial resources available to deliver quality patient care. The overall goal of SusQI is to maximise sustainable value. This means delivering the best possible health outcomes while minimising financial and environmental costs and adding positive social value at every opportunity.  

This means that as a team of ‘improvers’ and ‘innovators’ at CAV UHB, we are committed to making SusQI a part of our everyday work. Our work will be guided by the principles of sustainable clinical practice which includes prevention, patient empowerment and self-care, lean systems, and low carbon alternatives. 

An SUSQi example: Empowering Outpatients Challenge 

One example of this in action is through the Empowering Outpatients challenge where members of the Shaping Change team are actively supporting colleagues across the system at all levels to discharge outpatients onto See-on-Symptoms (SOS) and Patient-Initiated Follow-up (PIFU) pathways. These provide an alternative approach to follow-up appointments for people with short- and long-term conditions, respectively. Patients who are suitable for this approach will be empowered to initiate their own follow-up appointments as and when they need them, which might be after a flare-up of symptoms or a change in circumstances, for example, instead of being seen routinely in appointments they may not necessarily need. 

For our clinical teams, working in this way releases time to see complex patients, patients waiting for an initial appointment, and patients who are 100% past their target date without an appointment booked. It also helps clinicians to manage their caseloads and waiting lists. 

Feedback shows that these models of care lead to improved outcomes for patients, who can get appointments with their specialist team more easily outside of the usual routine follow-ups, as well as improved patient satisfaction as services are more responsive due to reduced waiting lists. They also reduce unneeded visits to hospital, which inevitably lead to high levels of “did not attend” (DNA) rates. 

Reducing DNA rates benefits everyone by reducing the waiting list for patients, reducing wasted clinical time, and reducing service costs. 

This way of working will allow our services to be much more agile, and responsive to patients’ needs. It will also help to reduce the travel time (and associated carbon emissions) for patients to and from our hospital sites. 

Many more of these positive changes and projects are taking place within our Health Board, both professionally and personally as individuals opt to reduce their environmental impact. The range of actions that we take together can cover everything from energy efficiency, recycling and plastic reduction, to reducing emissions from travel, supplementing green spaces or improving logistics. 

Everyone has a vital role in helping this change take place and a great deal of work is already happening. It’s important and encouraging to recognise that very often, simple changes can be highly effective.