Does quality of care entail environmental impact? A blind spot in our knowledge

This scoping review examines the conceptual relationship between the terms “environmental sustainability” and “quality of care” as used in academic studies on health care. We performed searches in Scopus and PubMed looking for potential semantic and practical associations between sustainability and quality of care, including potential conflicts. For the first part about associations, 11 search strings were used resulting in 1,488 studies of which 8 were eventually selected for analysis. For the latter part about conflicts, 4 search strings were used resulting in 45 studies of which 6 remained for analysis. Information about the following aspects was extracted from the studies that were included: interpretation and definition of sustainability, dimensions of quality of care, and tensions between quality and sustainability. Merely a few studies address a relationship betweenenvironmental sustainability and quality of care. Only “patient-centredness” and “safety” are associated with sustainability in academic literature. “Effectiveness” is rather interpreted as opposing it. “Efficiency” seems to be both associated and opposed to sustainability. The conceptual relationship between environmental sustainability and quality of care has not been thouroughly examined in academic studies which implies a blind spot in our knowledge. Only one study reports on conceptual and practical work for incorporating sustainability as a dimension of health care quality.