So we're going to talk about a model for sustainability so that you have an understanding of the theory that supports the notion of sustaining an intervention over the long term. I'm calling this "Marsteller's Sustainability Framework." It's informed by a lot of literature that comes out of the field of organizational behavior and organizational theory, and specifically Trish Greenwald's work, David Buchanan and Carl Wiker, all to be seen here, Ivash Wick and Auri as well. To try to summarize though, we're going to talk about innovation characteristics that will eventually affect outcome sustainability. There are characteristics of the change agent and the quality improvement team, their activities and their processes that will ultimately affect outcomes sustainability. And then, provider characteristics, those characteristics of the people that are being asked to change behavior or change the way they are doing things. And then finally, organizational context all affect the initial implementation that's undertaken, and then together those things will influence outcomes sustainability. So what's in the boxes? Well, you need to think of a couple of examples in your own, particular quality improvement or patient safety intervention that you're conducting. But to give you a sense of examples that can trigger your thought processes, in the area of the change agent activities, processes and characteristics, here we're talking about things like nurse and physician leadership. Their buy-in. The frequency of the meetings that the QI team undertakes. Communication. Looking at the quality improvement skills of the specific quality improvement team. Changes in the quality improvement team. Membership. Some people leaving, comings, and goings. Continued documentation and the ability of the team to bring in such things as new trainings or orientation. Adding specific QI intervention to orientation, or new written policies and so on. So those things will have a really fundamental impact on whether the intervention is used in the long term. The provider characteristics include things like: what's the safety climate at the time that you're trying to undertake the overall intervention, and what's the teamwork climate primarily around how different roles interact with each other and what expectations are across those roles. Organizational context items include things like: the bed size, perhaps. The teaching status. The region. If you're talking about a primary care organization, it would include things like: what's the staffing like within that organization? What kind of plant do they have there? Meaning, how is the office set up, do they have all the room that they need? Or are they really constrained for space, which we often see. These different organizational contextual factors also affect both the implementation and to your ultimate sustainment of the outcomes. Implementation characteristics include things like fidelity to the initial intervention. So did we implement this intervention the way that we should have or the way that it was supposed to be implemented? Did we adapt it to the point where it's unrecognizable as the original intervention? Adaptation is really important to make it fit with a specific context, but you want to know whether it completely went off the ranch and doesn't match anything that was originally intended. Customization, as I said, is actually encouraged in most cases up to a point. Other things that you might consider are the time to zero infections or other kinds of measures of how well the implementation went. Because if it went well, it's actually going to have a better effect on your sustainment than an intervention or intervention implementation that did not go well, that's much less likely to be sustained over time. And then finally, whatever successes you were able to have should be measured in the long run to see whether those successes are still continuing. And you want to look at both the outcome of the clinical intervention and some cultural outcomes such as teamwork climate in the late period or your safety climate in the late period after having undertaken your intervention.
