{"id":1152,"date":"2026-05-01T07:00:21","date_gmt":"2026-05-01T07:00:21","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1152"},"modified":"2026-04-22T10:01:08","modified_gmt":"2026-04-22T10:01:08","slug":"education-as-infrastructure-embedding-sustainability-through-leadership-in-the-nhs-by-imogen-stringer-and-nicola-wilson","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2026\/05\/01\/education-as-infrastructure-embedding-sustainability-through-leadership-in-the-nhs-by-imogen-stringer-and-nicola-wilson\/","title":{"rendered":"Education as infrastructure: embedding sustainability through leadership in the NHS. By Imogen Stringer and Nicola Wilson"},"content":{"rendered":"

Introduction<\/b>\u00a0<\/span><\/p>\n

The NHS has set a globally ambitious goal to become the world\u2019s first net zero health system. Achieving this ambition will require more than technological innovation or capital investment; it depends on how effectively strategic intent is translated into everyday clinical and operational practice.\u00a0<\/span>
\n<\/span>At Great Ormond Street Hospital (GOSH), the establishment of a Head of Education for Sustainability role offered an opportunity to explore a different approach: positioning education not as a supplementary activity, but as a form of organisational infrastructure. This article reflects on that experience as one practical step towards embedding sustainability through workforce capability and leadership.\u00a0<\/span><\/p>\n

Addressing the implementation gap<\/b>\u00a0<\/span><\/p>\n

A persistent challenge in delivering sustainable healthcare is the gap between high-level policy and frontline reality. National strategies such as\u00a0<\/span>Delivering a Net Zero NHS<\/span><\/i>\u00a0articulate clear expectations, yet implementation relies on workforce capability, engagement, and behaviour change (NHS England, 2020).\u00a0<\/span>
\n<\/span>This role was designed to work directly in this space. Rather than introducing new policies or standalone initiatives, sustainability was embedded within existing education systems. This enabled sustainability to be systematically taught, integrated into established training pathways, and aligned with quality improvement (QI), governance, and regulatory requirements.\u00a0<\/span>
\n<\/span>The intention was not to add another initiative for staff, but to support teams to understand what sustainability meant within decisions they were already making clinically, operationally, and organisationally.\u00a0<\/span><\/p>\n

Education as an enabler for system change<\/b>\u00a0<\/span><\/p>\n

Over a two-year period, the role supported a broad programme of education-led activity, including digital learning modules, study days, podcasts, and coaching for staff-led improvement projects. Engagement extended across clinical and non-clinical roles, reflecting the reality that sustainability outcomes are shaped across the system.\u00a0<\/span>
\n<\/span>Education functioned less as awareness-raising and more as enablement. Staff feedback highlighted the value of practical, contextualised learning that supported decision-making rather than prescribing solutions. Training created space for discussion, allowing teams to explore how sustainability intersects with patient safety, quality, and efficiency.\u00a0<\/span>
\n<\/span>One illustrative example was circular-economy teaching with Infection Prevention and Control (IPC) Link Nurses. Sessions introduced core principles and invited reflection on how these aligned with IPC priorities in real clinical contexts, generating stakeholder insight and strengthening relationships.\u00a0<\/span><\/p>\n

Integrating sustainability and quality improvement<\/b>\u00a0<\/span><\/p>\n

A notable strength of the role was its close alignment with quality improvement. Programmes such as the GOSH Goes Green staff competitions\u00a0demonstrated\u00a0how sustainability\u00a0objectives\u00a0could be embedded within familiar QI frameworks, enabling teams to test ideas, measure impact, and focus on patient-centred outcomes.\u00a0<\/span>
\n<\/span>Projects addressed themes including equipment use, medicines, theatre practice, and service design. Environmental benefits often\u00a0emerged\u00a0alongside improvements in staff time, patient experience, safety, and cost, supporting \u201ctriple bottom line\u201d outcomes. This aligns with emerging national guidance on sustainable QI and reinforces the importance of integrating sustainability within core operational priorities (NHS England, 2022).\u00a0<\/span>
\n<\/span>The experiential learning model also supported sustained engagement, with many teams remaining involved beyond individual projects and continuing to develop capability over time.\u00a0<\/span><\/p>\n

A boundary-spanning leadership role<\/b>\u00a0<\/span><\/p>\n

The effectiveness of the role lay in its hybrid positioning across education, clinical practice, sustainability, and external networks. Operating across traditional organisational boundaries, it helped connect clinical and non-clinical domains, education and service delivery, and internal priorities with external partners. In doing so, it addressed a key structural barrier to delivering sustainable healthcare of fragmentation by focusing on enabling others. Rather than owning solutions, the role supported subject-matter experts and clinical leaders to lead change within their areas. This boundary-spanning function is increasingly recognised as critical in complex systems (Best\u202fet\u202fal.,\u202f2012).\u00a0<\/span><\/p>\n

A step within wider system change<\/b>\u00a0<\/span><\/p>\n

It would be unrealistic to describe this work as transformational in isolation. Instead, it\u00a0represents\u00a0one contribution to a broader organisational journey. Delivered at limited WTE, the role functioned as a force multiplier, supporting education infrastructure and enabling staff-led initiatives with measurable environmental, financial, and quality benefits. Tangible returns included cost savings, reductions in waste and carbon emissions, enhanced staff engagement, and increased organisational visibility supporting partnerships. Equally important was a shift in how sustainability conversations were approached, with staff reporting greater confidence discussing sustainability alongside risk and care quality.\u00a0<\/span><\/p>\n

Reflections for NHS leaders<\/b>\u00a0<\/span><\/p>\n

Several tentative lessons\u00a0emerge\u00a0for system leaders. Achieving net zero healthcare requires investment in workforce capability alongside physical infrastructure. Embedding sustainability within existing education and QI systems can build momentum without adding unnecessary burden. Hybrid leadership roles that span organisational boundaries may be particularly valuable in addressing complex system-level challenges such as climate change.\u00a0<\/span>
\n<\/span>This is not a universal model, and local context will matter. However, the experience at GOSH suggests that education-led approaches can play a meaningful role in translating ambition into everyday practice.\u00a0<\/span><\/p>\n

Conclusion<\/b>\u00a0<\/span><\/p>\n

The transition to sustainable healthcare is fundamentally a people challenge. At GOSH, the Head of Education for Sustainability role has offered one way of supporting that transition by using education to connect strategy with practice, and sustainability with quality.\u00a0<\/span>
\n<\/span>This work\u00a0remains\u00a0ongoing. It is shared not as a finished answer, but as an invitation: to reflect on how education functions within healthcare organisations, to consider sustainability as part of core professional practice, and to continue learning together as we move from aspiration to delivery (WHO, 2021).\u00a0<\/span><\/p>\n

References:<\/b><\/p>\n

NHS England (2020) <\/span>Delivering a \u2018Net Zero\u2019 National Health Service<\/span><\/i>. Available at: <\/span>https:\/\/www.england.nhs.uk\/greenernhs\/publication\/delivering-a-net-zero-national-health-service\/<\/span><\/a> (Accessed: 17 April 2026).<\/span><\/p>\n

NHS England (2022) <\/span>Towards a Net Zero NHS: Carbon Reduction Strategy Update<\/span><\/i>. Available at: https:\/\/www.england.nhs.uk\/greenernhs\/publication\/towards-a-net-zero-nhs-carbon-reduction-strategy-update\/ (Accessed: 17 April 2026).<\/span><\/p>\n

World Health Organization (2021) <\/span>Climate-resilient health systems: key principles and guidance for implementation<\/span><\/i>. Geneva: World Health Organization. Available at: https:\/\/www.who.int\/publications\/i\/item\/9789240027008 (Accessed: 17 April 2026).<\/span><\/p>\n

Health Education England (2021) <\/span>Educating for a Sustainable Healthcare System: A Framework for Action<\/span><\/i>. Available at: https:\/\/www.hee.nhs.uk\/our-work\/sustainability-climate-change (Accessed: 17 April 2026).<\/span><\/p>\n

Best, A., Greenhalgh, T., Lewis, S., Saul, J.E., Carroll, S. and Bitz, J. (2012) \u2018Large-system transformation in health care: a realist review\u2019, <\/span>Milbank Quarterly<\/span><\/i>, 90(3), pp. 421\u2013456. Available at: https:\/\/doi.org\/10.1111\/j.1468-0009.2012.00670.x (Accessed: 17 April 2026).<\/span><\/p>\n

The Lancet Countdown (2023) <\/span>The 2023 report of the Lancet Countdown on health and climate change<\/span><\/i>. Available at: <\/span>https:\/\/www.lancetcountdown.org\/2023-report\/<\/span><\/a> (Accessed: 17 April 2026).<\/span><\/p>\n

Authors<\/strong><\/p>\n

Imogen Stringer<\/strong><\/p>\n

\"\"<\/p>\n

Imogen is a critical care nurse and Head of Education for Sustainability and Implementation Manager at Great Ormond Street Hospital, London. She previously served as a Clinical Fellow to NHS England\u2019s Chief Sustainability Officer, contributing to national programmes on climate change and health. With a background in intensive care and clinical education, her work focuses on embedding sustainability into healthcare practice. Imogen is an active contributor to Healthcare Without Harm\u2019s Born Green Generation initiative and a nursing advocate on the global stage, having presented at COP29 and COP30 on the health impacts of climate change and plastics.<\/span><\/em><\/p>\n

Nicola Wilson<\/strong><\/p>\n

\"\"<\/p>\n

Nicola is an experienced paediatric nurse with a background in neurosciences, having worked across multiple hospital settings. Over the past decade, she has worked as a clinical educator, becoming a qualified teacher and embracing the practical aspects of the role\u2014from\u00a0facilitating\u00a0bedside learning to leading a team of educators across Great Ormond Street Hospital.\u00a0<\/span><\/em><\/p>\n

Nicola is passionate about\u00a0leveraging\u00a0education to drive quality improvement initiatives that enhance patient care, support staff well-being, and promote environmental sustainability. She co-led the award-winning \u201cGloves Are Off\u201d project at Great Ormond Street Hospital (GOSH), now recognised globally as an exemplar in sustainable healthcare practice.\u00a0<\/span><\/em><\/p>\n

Her commitment to sustainability is further strengthened by her leadership of the\u00a0Born Green Project\u2014a movement supported by Healthcare Without Harm. This initiative aims to protect babies\u2019 health and development during their first 1,000 days by reducing single-use plastics and toxic chemicals in maternity and paediatric units across Europe and beyond.\u00a0<\/span><\/em><\/p>\n

Declarations of Interest<\/strong><\/p>\n

No interests to disclose.<\/p>\n","protected":false},"excerpt":{"rendered":"

Introduction\u00a0 The NHS has set a globally ambitious goal to become the world\u2019s first net zero health system. Achieving this ambition will require more than technological innovation or capital investment; it depends on how effectively strategic intent is translated into everyday clinical and operational practice.\u00a0 At Great Ormond Street Hospital (GOSH), the establishment of a […]<\/p>\n

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