Friday, 18 May 2012

Sustainabilty of QI results; we're not sure how to make it happen

I love systematic reviews. Someone else does the hard work of synthesising the literature and pointing out the strengths and weaknesses.

If you come across anyone purporting to tell you how you can sustain the results of your improvement work, then send them this paper.  Basically, we're not sure how sustainability happens other than it is a complex matter, and not one for a checklist or one day seminar. What I like about this systematic review is it points out the complexity, the system dynamics issues and the need for published work to identify the contextual factors in the sustainability (or not) or results.

Excellent work here by the authors.
Thank you.

Implement Sci. 2012 Mar 14;7(1):17. [Epub ahead of print]
The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research.
Wiltsey Stirman SKimberly JCook NCalloway ACastro FCharns M.

Partial Abstract

Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves.
Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment."

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