Abstract
BackgroundMany healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. Although there have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the ‘staying power’ of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was sustained over a long-term period in an acute healthcare centre.MethodsWe conducted a qualitative descriptive case study to examine the program’s sustainability at the nursing department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada. The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following program initiation through 14 key informant interviews, document reviews, and observations. We developed a framework for the sustainability of healthcare innovations to guide data collection and content analysis.ResultsProgram sustainability entailed a combination of three essential characteristics: benefits, institutionalization, and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing program sustainability and characteristics of program sustainability accounted for how the program had been sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership actions and both institutionalization and development; and a reflection-and-course-correction strategy and development.ConclusionsStudy findings indicate that the successful initial implementation of an organizational program does not automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or program benefits. The development of an organizational program may be necessary for its long-term survival.
Highlights
Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements
How the program was sustained: key relationships between characteristics and factors we have summarized separately the characteristics of and the factors that influenced best practice guidelines (BPG) program sustainability, it was descriptions about the complex relationships between characteristics and factors that provided the explanations for how the program had been sustained within the nursing department
Some aspects of the framework were more prominent than others in accounting for the sustainability of a BPG program at the nursing department level of the organization
Summary
Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. There have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the ‘staying power’ of healthcare innovations. Innovation decay wastes implementation investments and results in the loss of often desperately-needed initial improvements [3]. Despite advances in knowledge about innovation implementation (e.g., [4, 5]), there has been considerably less attention paid to understanding what happens following the preliminary stages of change [1, 6]. Sustainability refers to the period following the initial implementation of an innovation, there is considerable range in the literature regarding timeframes specified (i.e., from 6 months to several decades following initial implementation) [1, 10, 11]
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