Qual Saf Health Care 19:260-261 doi:10.1136/qshc.2010.044123
  • Editorial

Place sustainability at the heart of the quality agenda

  1. Paul A Cosford
  1. NHS East of England, Fulbourn, Cambridge, UK
  1. Correspondence to Dr Justyn Thomas, NHS East of England, Victoria House, Capital Park, Fulbourn, Cambridge CB21 5XB, UK; justyn.m.thomas{at}

    If the guiding ethos of health systems throughout the world were ‘live for the day,’ two pillars of quality would suffice. Effective use of finite resources, measured by evidence-based outcomes relating to patient health, safety and experience is, without question, the predominant pillar.1–5 Next to effectiveness is its close ally, efficiency.3 Efficient use of resources minimises waste, thus maximising the quantity of high-quality healthcare and, in combination, with effectiveness provides the critical measure of productivity.

    Risks of living for the day

    Living for the day, however, is a high-risk mindset, and if a health system is also to prosper ‘tomorrow,’ a sensible precaution must be to embrace a further pillar of quality: sustainability. Put simply, this concerns the use of resources in a way to build, rather than undermine, operative resilience for the future delivery of high-quality healthcare.6

    Risk to quality, due to misuse of resources, arises both externally and internally. External risk results from using resources in a way that destabilises the foundations of the interconnected economic, societal or environmental world in which the health system operates. Internal risk results from using resources in a way …