Towards Higher Quality, Safer Care: ISQua Launches Second Green Paper on Health System Decarbonisation

New position paper calls on healthcare leaders worldwide to make decarbonisation a core component of quality and patient safety

The International Society for Quality in Health Care (ISQua) is proud to announce the launch of its second Green Paper, Towards Higher Quality, Safer Care: Reducing Greenhouse Gases – The 2nd ISQua Green Paper: A Call to Action on Health System Decarbonisation.

At a time when climate change is placing unprecedented pressure on health systems worldwide, the Green Paper provides an evidence-based roadmap to help healthcare organisations reduce greenhouse gas emissions while strengthening patient safety, improving quality of care, and building more resilient health systems.

The publication reinforces ISQua’s belief that environmental sustainability is no longer separate from healthcare quality—it is fundamental to delivering safe, effective, equitable and person-centred care for current and future generations.

Developed over an 18-month international collaboration led by translational researchers from the Observatory on the Future of Healthcare within the Australian Institute of Health Innovation (AIHI), Macquarie University, the Green Paper draws on extensive consultation with ISQua members and global healthcare experts. It synthesises evidence from a systematic review of 205 studies across 26 countries, translating research into practical actions for healthcare leaders, policymakers, clinicians and quality professionals.

A Practical Call to Action

Health systems are on the front line of climate impacts while also being significant contributors to greenhouse gas (GHG) emissions. This creates a dual challenge: to decarbonise healthcare while strengthening resilience against climate-related harm amid rising demand, rapid technological change and workforce constraints.

The Green Paper argues that addressing this challenge requires healthcare to move beyond “business as usual” by embedding decarbonisation into everyday quality improvement and patient safety activities.

A central theme is the importance of tackling Scope 3 emissions—those generated through purchased goods and services—which account for more than 80% of healthcare emissions globally. These include pharmaceuticals, medical equipment, consumables, food and complex healthcare supply chains.

To support meaningful action, the Green Paper presents practical recommendations across four strategic areas:

  • Policy and governance
  • Organisational behaviour change
  • Individual and team action
  • Measurement, monitoring and improvement

It also identifies five key areas where health systems can achieve meaningful reductions in emissions while improving care:

  • Clinical practice
  • Healthcare waste
  • Travel and transport
  • Infrastructure and energy
  • Sustainable procurement and supply chains

Throughout the publication, environmental stewardship is presented not as an additional responsibility, but as an essential component of safer, higher-quality healthcare.

Healthcare Quality and Sustainability Go Hand in Hand

Professor Jeffrey Braithwaite, AIHI Founding Director and lead author of the Green Paper, believes healthcare has a critical role to play in addressing the climate crisis.

“The evidence is now overwhelming: healthcare must be part of the solution to climate change. This Green Paper provides a practical roadmap for health systems worldwide to reduce emissions while simultaneously delivering safer, higher-quality care. Decarbonisation is no longer an optional extra. It is core business for modern healthcare.

Our message is simple: greener care is better care.”

ISQua President, Ezequiel Garcia Elorrio, said the Green Paper reflects ISQua’s commitment to helping health systems address one of the defining challenges of our time.

“Healthcare quality and environmental sustainability are inseparable. As health systems face increasing pressures from climate change, resource constraints and growing demand, we have a responsibility to lead by example. This Green Paper demonstrates that reducing greenhouse gas emissions is not only an environmental imperative, but also an opportunity to improve patient safety, strengthen health system resilience, and deliver higher-quality care. ISQua is proud to provide this evidence-informed call to action, supporting healthcare leaders around the world to accelerate the transition towards safer, more sustainable health systems. Together, we can ensure that greener care is truly better care.”

ISQua President-Elect, Ellen Joan van Vliet, highlighted the opportunity for healthcare leaders to turn ambition into meaningful action.

“Protecting people’s health starts with protecting the planet. This Green Paper empowers health leaders everywhere to transform ambition into action and build safer, stronger, and more sustainable health systems.”

Supporting Healthcare’s Journey to Net Zero

The second Green Paper builds upon ISQua’s ongoing commitment to advancing healthcare quality globally by providing members and the wider health community with practical, evidence-informed guidance on one of the defining challenges facing healthcare today.

As countries work towards net-zero commitments, healthcare organisations have an opportunity to reduce their environmental impact while improving efficiency, resilience and outcomes for patients. The Green Paper demonstrates that these goals are not competing priorities—they are mutually reinforcing.

By integrating sustainability into quality improvement, patient safety and organisational leadership, healthcare systems can create lasting benefits for patients, staff, communities and the planet.

The Green Paper is intended to support ISQua members, policymakers, healthcare providers, researchers and quality professionals in taking practical, measurable steps towards decarbonisation while maintaining the highest standards of care. It reflects ISQua’s continuing commitment to championing innovation, collaboration and evidence-based improvement across global health systems.

Access the Green Paper

ISQua invites healthcare leaders, policymakers, quality professionals, researchers and practitioners around the world to explore the Green Paper and join the movement towards safer, higher-quality, lower-carbon healthcare.

Towards Higher Quality, Safer Care: Reducing Greenhouse Gases – The 2nd ISQua Green Paper: A Call to Action on Health System Decarbonisation is available to download from the ISQua website. Please note that you must log in as an ISQua Guest or Member to access.

Together, we can build health systems that are more sustainable, more resilient and better equipped to meet the needs of future generations.

This paper will be officially launched by Ezequiel Garcia Elorrio, ISQua President, at the opening of our 42nd International Conference, in Dublin, Ireland (27th – 30th September 2026) on 28th September. Lead author, Jeffrey Braithwaite, will present more on the paper during the ‘Meet the ISQua Academy: The International Academy of Quality & Safety (IAQS)‘ session, followed by a Q&A. This session will take place at 12:15 on 28th September. Please check our programme closer to the time for more information.

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Nourhan Kawtharani

Nourhan, a quality and safety coordinator with eight years of experience in ambulatory healthcare in Lebanon, aims to deepen her understanding of the systemic and holistic approach to healthcare through this fellowship.

She aims to identify gaps and develop tailored interventions that address specific contexts rather than applying general solutions. Engaging with diverse professionals and perspectives during this educational journey will expand the application of these concepts across different cultural settings.

Nourhan emphasizes the importance of promoting a culture of continuous learning and improvement within healthcare institutions, considering it a vital leadership responsibility to integrate quality and safety initiatives into the organizational culture.

Nourhan's commitment to patient safety and quality management includes sourcing practical resources and transforming insights into actionable knowledge to drive continued progress in healthcare practices and outcomes.

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Elom Otchi

Elom is passionate about improving quality of care and patient safety outcomes.

In view of this, he has had the opportunity to work in various capacities with various organisations including AfIHQSA, WHO, UNICEF and others undertaking research, supporting the development of national quality policies and strategies, facilitating the establishment of quality governance systems across all the levels of the health sector and building capacity of national and sub-national quality leads/teams to institutionalize the practice of quality and patient safety across the continent.

He has also worked extensively across all levels of care in the health sector of Ghana, including leading the Quality & Patient Safety program in its largest teaching hospital.

I would like to use this Fellowship as a learning platform and an opportunity to acquire the requisite knowledge, skills and competencies to complement ongoing efforts by like-minded individuals and organizations to continuously advance improve the quality and patient safety in Ghana and the continent.

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Stephen Taiye Balogun

Stephen is a Senior Programme Officer at the Institute of Human Virology in Nigeria as well as Country Representative for Health Information for All (HIFA).

Stephen plans to use this opportunity to maximise his impact by championing the cause of patient safety and quality in Nigeria and across Africa.

Stephen says "Quality and safety is a major wheel through which universal healthcare coverage can be achieved. The goal is to be a bridge in the gap between the International Quality Improvement and Patient Safety community and my country to ensure rapid spread, adoption, implementation and practice."

We are looking forward to working with both Stephen and our 2020 winner Rhoda Kalondu over the next year.

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Dr Rhoda Kalondu

Rhoda is the Head of the Patient Safety Unit at Kenyatta Hospital in Nairobi and wants to use this Fellowship to learn how to establish a culture of safety and develop systems for assessment and analysis at her institution, and more widely. As well as this, Rhoda intends to develop and execute an intervention to improve patient safety in Kenyatta National Hospital.

It is one thing to institute measures and processes for improvement, but quite another to change the culture of an environment. Rhoda's ambition to lead others in this change inspired the panel.

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Dr Subhrojyoti Bhowmick

I am an MBBS graduate from Calcutta University with a Gold Medal in Gynecology & Obstetrics.

I have completed M.D in Pharmacology from IPGME& R, Kolkata and have over 12 years of experience in the field of Clinical Research, Pharmacovigilance and Medication management in Hospitals.

I have completed certification in Clinical Research Administration & Project Management from Stanford University, USA and in Patient Safety from Johns Hopkins University, USA.

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I have published several research articles and have also authored a chapter on “Regulations governing Clinical Trial” in the book “Fundamentals of Clinical Trial & Research”.

I am a peer reviewer for prestigious international journals like the British Journal of Clinical Pharmacology, CNS Drugs and Drug Safety case reports.

I am the recipient of the UK Seth Oration Award for Best Clinical Pharmacology paper by the Indian Pharmacological Society in 2009 and the “Most promising Healthcare professional in Patient Safety in India” award by the Asian African Chamber of Commerce and Industry in October 2018.

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I have a keen interest in teaching and am visiting adjunct faculty of Pharmacology at KMC, Mangalore, India and for Healthcare technology at MAKAUT, Kolkata, India.

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Currently, I am working as the Clinical Director of Academics, Medical Quality and Clinical Research at Peerless Hospital and B K Roy Research Centre, Kolkata.

I am very happy and thrilled to receive the prestigious ISQua Lucian Leape Patient safety Fellowship Award for 2019 and I look forward to honing my skills further in the field of healthcare quality and patient safety through my experiences during this fellowship.

I sincerely believe that successful completion of this fellowship will help me evolve as a more confident Patient safety leader in India who in turn can provide significant inputs on policy changes through NABH for the Indian healthcare system.

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