Abstract
BackgroundOne of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability actually means. Several reviews have helped synthesize and clarify how researchers conceptualize and operationalize sustainability. In this study, we sought to identify how individuals who implement and/or sustain evidence-informed innovations in health care define sustainability.MethodsWe conducted in-depth, semi-structured interviews with implementation leaders and relevant staff involved in the implementation of evidence-based innovations relevant to cancer survivorship care (n = 27). An inductive approach, using constant comparative analysis, was used for analysis of interview transcripts and field notes.ResultsParticipants described sustainability as an ongoing and dynamic process that incorporates three key concepts and four important conditions. The key concepts were: (1) continued capacity to deliver the innovation, (2) continued delivery of the innovation, and (3) continued receipt of benefits. The key conditions related to (2) and (3), and included: (2a) innovations must continue in the absence of the champion or person/team who introduced it and (3a) adaptation is critical to ensuring relevancy and fit, and thus to delivering the intended benefits.ConclusionsParticipants provided a nuanced view of sustainability, with both continued delivery and continued benefits only relevant under certain conditions. The findings reveal the interconnected elements of what sustainability means in practice, providing a unique and important perspective to the academic literature.
Highlights
One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability means
Whereas others have proposed definitions based on concepts related to sustainability identified within the existing literature [18,19,20], this study aims to identify how individuals involved in the implementation and/or sustainment of evidence-informed innovations in health care define sustainability
Continued capacity Participants continually described sustainability as a process that must encompass a continued capacity to deliver an innovation over time
Summary
One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability means. We know that new knowledge and tools are often put into practice but their use and/or benefits are not sustained [6] That is, they do not become integrated into the longterm routines of organizations [7,8,9] and, as a result, patients do not benefit from the best care possible [10,11,12]. One of the key conceptual challenges in advancing our Urquhart et al BMC Health Services Research (2020) 20:87 understanding of how to more effectively sustain innovations is the lack of clarity and agreement on what sustainability means [6, 17, 18]. A standard definition is needed by practitioners and researchers to guide sustainability planning, and to inform evaluation efforts through the operationalization of sustainability outcomes and the development and application of psychometrically strong and pragmatic measures
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