Abstract
BackgroundA greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments.MethodsWe approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007–2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results.ResultsWe used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies’ current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of original study outcome goals. Available quantitative data on wait-time reduction demonstrated general concordance between agency perceptions of, and evidence for, sustainment 2 years following the end of the intervention. Additional quantitative data suggested that greater engagement during the intervention period showed some association with sustainment.ConclusionsFactors identified in QI frameworks as important for short-term sustainment—organizational capacity (e.g. staffing and leadership) and intervention characteristics (e.g. flexibility and fit)—are also important to long-term sustainment.
Highlights
A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments
Important intervention characteristics include the value of innovations to the agency [13], and the flexibility to adapt intervention components to fit within an agency [14]
The goal of the current study was to assess from participating agencies which, if any, organizational practices or outcomes were sustained 6–7 years following the completion of the NIATx200 intervention
Summary
A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. Three factors important to sustainment have been described across numerous studies: agency characteristics, intervention characteristics, and the external environment. External factors include funding availability [13] and institutional climate [12]. How these factors coalesce into sustainment, and in which circumstances each component is a necessary precondition for sustainment, is a matter of debate [4, 7, 14, 15]. Some studies have utilized interviews or administrative data to examine sustainability one to 3 years post-intervention [16,17,18] or even over a longerterm [19,20,21]
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