Too many attempts to improve care using new evidence-based practice fail to sustain, creating waste and failing to deliver consistent high quality care. There is a clear need to understand why this happens and how it can be avoided in order to save limited resources and ensure optimal care for patients.
The aim of this project is to develop a sophisticated understanding of the factors that influence sustainability both during implementation or improvement initiatives and afterward and investigate strategies used to influence sustainability within healthcare initiatives and their impact.
Using this knowledge, it also aims to provide a practical tool that will help project teams identify what action they can take to maximise their chances of sustaining their improvements in the long term.
The project will describe the application of this framework and explore its impact on processes and outcomes within improvement projects.
Outcome & Impact statement
This project aimed to develop a practical, user-friendly approach for teams to assess and promote long term success of their projects as well as assess its use and impact in practice. From 2008-2013 project teams supported by CLAHRC NWL used the NHS Institute for Innovation and Improvement Sustainability Model to help teams identify factors affecting sustainability and take action to improve long term success. Securing engagement with the model was a significant challenge.
In 2014-15 an adaptation of this tool was produced. A literature review, facilitated group discussions and interviews from CLAHRC stakeholders to contribute their thoughts on the content and design of the tool (e.g. the relevance of the factors, the wording of the concepts used, missing factors, accessibility, ease of completion in a busy work environment). A pilot version was trialled with stakeholders including past and current project members, academic and industry partners, and patients and carers. The Long Term Success Tool is now being used by CLAHRC project teams to identify risks in the early stages of project development and to take action to manage and mitigate these risks.
This work will be presented at the 2015 UK Knowledge Mobilisation Forum and submissions to The Health Services Research Network (HSRN) Symposium and The International Society for Quality in Health Care Conference have been made. A publication on tool development is in progress to be submitted to the BMJ Quality and Safety Journal in April 2015.
A Phd is being undertaken both to continue testing and refining this tool, and to explore the processes by which healthcare teams influence the sustainability of improvement initiatives. The PhD research plan associated with this work has been approved by The Department of Medicine at Imperial College with upgrading taking place in December 2015.
What happened next?
The tool is now being tested by all improvement teams at CLAHRC NWL. Further adaptations of the tool are planned in the next year to respond to user needs and assess overall impact in practice.