Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions

Affiliations

¹ School of Nursing, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China. yuting.song@ualberta.ca.
² Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada. yuting.song@ualberta.ca.
³ Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada.
⁴ Max Rady College of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
⁵ School of Health Policy & Management, York University, Stong College 353, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
⁶ Department of Family Medicine, University of Alberta, 6-50 University Terrace, Edmonton, AB, T6G 2T4, Canada.
⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada.
⁸ Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.
⁹ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada.
¹⁰ Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada.
¹¹ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
¹² Department of Medicine, University of Alberta, 1-198 Clinical Sciences building, 11350 - 83Avenue, Edmonton, AB, T6G 2P4, Canada.
¹³ Nova Scotia Centre On Aging, Mount Saint Vincent University, McCain 201F, 166 Bedford Hwy, Halifax, NS, B3M 2J6, Canada.

PMID: 35581651
PMCID: PMC9116057
DOI: 10.1186/s12913-022-08026-x

Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions

Yuting Song et al. BMC Health Serv Res. 2022.

. 2022 May 17;22(1):666.

doi: 10.1186/s12913-022-08026-x.

Authors

Affiliations

¹ School of Nursing, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China. yuting.song@ualberta.ca.
² Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada. yuting.song@ualberta.ca.
³ Management & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada.
⁴ Max Rady College of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
⁵ School of Health Policy & Management, York University, Stong College 353, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
⁶ Department of Family Medicine, University of Alberta, 6-50 University Terrace, Edmonton, AB, T6G 2T4, Canada.
⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada.
⁸ Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.
⁹ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada.
¹⁰ Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada.
¹¹ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
¹² Department of Medicine, University of Alberta, 1-198 Clinical Sciences building, 11350 - 83Avenue, Edmonton, AB, T6G 2P4, Canada.
¹³ Nova Scotia Centre On Aging, Mount Saint Vincent University, McCain 201F, 166 Bedford Hwy, Halifax, NS, B3M 2J6, Canada.

PMID: 35581651
PMCID: PMC9116057
DOI: 10.1186/s12913-022-08026-x

Abstract

Background: Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation.

Methods: Data were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis.

Results: Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system.

Conclusions: Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction.

Keywords: Caregiving – Formal; Implementation Science; Long-term Care; Management.

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Conflict of interest statement

The authors declare that they have no completing interests.

Figures

**Fig. 1**
Relationships among Post-Implementation Factors & Sustainability Phenomena

See this image and copyright information in PMC

References

1. Khan S, Vandermorris A, Shepherd J, Begun JW, Lanham HJ, Uhl-Bien M, et al. Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems. BMC Health Serv Res. 2018;18(1):192. doi: 10.1186/s12913-018-2994-0. - DOI - PMC - PubMed
1. Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012;7(1):17. doi: 10.1186/1748-5908-7-17. - DOI - PMC - PubMed
1. Herlitz L, MacIntyre H, Osborn T, Bonell C. The sustainability of public health interventions in schools: a systematic review. Implement Sci. 2020;15(1):1–28. doi: 10.1186/s13012-019-0961-8. - DOI - PMC - PubMed
1. Olomu AB, Stommel M, Holmes-Rovner MM, Prieto AR, Corser WD, Gourineni V, et al. Is quality improvement sustainable? Findings of the American college of cardiology's guidelines applied in practice. Int J Qual Health Care. 2014;26(3):215–222. doi: 10.1093/intqhc/mzu030. - DOI - PubMed
1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. doi: 10.1111/j.0887-378X.2004.00325.x. - DOI - PMC - PubMed

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Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions

Affiliations

Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources