Sustainability in Action: A Financial Incentive for Trainees Embracing Environmentally Friendly Quality Improvement Projects.

Engaging and motivating busy trainees to work on reducing the climate impact of their clinical practice is challenging. To our knowledge, there are no published studies of graduate medical education (GME)-wide, institutional efforts to engage residents in implementing climate sustainability improvement projects. We piloted a novel, institution-wide, pay-for-performance (P4P) sustainability quality improvement (SusQI) program in 2023-2024 that enabled residents from all GME programs to implement SusQI projects with practice-changing improvement goals for a financial incentive. Project leaders were provided an opportunity to implement a project by identifying a SusQI problem and collaborating with stakeholders toward meeting environmentally friendly monthly improvement goals for an incentive payment. Eligible residents who reached their monthly goal for 6 months of the academic year would receive $400. Of the 4 SusQI projects approved for the P4P program, 3 remained active after 6 months. One project stalled because of institutional barriers. Two hundred and ten residents participated. Environmental impacts included an increase in low anesthetic gas flow use in operating room cases (mean [SD] 25% to 53% [0.1]), increase of radiology workroom waste sorting into recycling and composting bins (mean [SD] 20% to 58% [0.1]), and increase in emergency department instruments recycled (mean [SD] 9% to 24% [0.2]). Two hundred and ten residents are set to receive $84,000 at the end of the year for meeting their SusQI goals. We were able to integrate sustainability into QI programs by implementing an institution-wide pay-for-performance SusQI program that encouraged residents to develop and implement environmentally friendly practice projects.