SynthesisBMJ open2020
Built to last? The sustainability of healthcare system improvements, programmes and interventions: a systematic integrative review.
Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Effectiveness and economic impact of interventions targeting healthcare personnel: a systematic review of return on investment.Public health reviews · 2026Pooled it
- Service-level interventions to reduce waiting time in outpatient and community health settings may be sustained: a systematic review.BMJ open quality · 2025Pooled it
- Health system strengthening in fragile and conflict-affected states: A review of systematic reviews.PloS one · 2024Pooled it
- Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.Implementation science : IS · 2023Pooled it
- Managers' experiences of implementing palliative care in nursing homes: a qualitative follow-up study after an educational intervention for the staff.BMC palliative care · 2026Trial
- Trial
- The intent is good but… exploring barriers and enablers to clinical pathway use in regional Australian Emergency Departments.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
- Long-Term, Low-Maintenance, and Impactful: Lessons Learned From Sustaining the NOHARM Pragmatic Clinical Trial.Learning health systems · 2026Article
- Community-Driven Research Priorities for Genetic Counseling: Shaping the Future of Genetic Counseling Research by Centering Multicultural Perspectives.Journal of genetic counseling · 2026Article
- What Matters in Sustaining Peer Support for Adults in Mental Health Services? Exploring the Perceptions of Diverse Actors.Community mental health journal · 2026Article
- Stroke Coordinators' Perspectives on Sustaining Use of Fever, Sugar (Hyperglycaemia) and Swallow (FeSS) Protocols. Process Evaluation Using a Sustainability Framework.Journal of advanced nursing · 2026Article
- Retrospective Evaluation of the Implementation of Universal Suicide Risk Screening for Youth in the Perioperative and Procedural Areas of a Health System.Paediatric anaesthesia · 2026Article
- From Theory to Practice: A Qualitative Study Exploring Change Managers' Experiences Applying Change Management Frameworks in Hospital Redevelopment Across One Australian State.Journal of healthcare leadership · 2026Article
- Perceptions of Factors Associated With Sustainability of Evidence-Based Nursing Practice: A Sequential Mixed Methods Study.Journal of nursing management · 2026Article
- Implementation and knowledge translation of health promotion programs at scale: "a perspective article".Frontiers in public health · 2026Article
- One health-sustainability intersections: an umbrella systematic review with a new integrated definition of sustainability and a meta-conceptual framework.One health outlook · 2025Review
- Synergising one health and environmental, social, and governance (ESG) standards: A scoping review.One health (Amsterdam, Netherlands) · 2025Review
- Emergency Department Implementation of a Multimodal Electronic Health Record-Integrated Clinical Intervention for High-Sensitivity Troponin Testing Increases Diagnostic Efficiency.Journal of the American College of Emergency Physicians open · 2025Article
- Chasing environmental sustainability in healthcare organizations: insights from the Italian experience.BMC health services research · 2025Article
- Charting progress in learning health systems: A systematic review of 5 years of definitions, models, and frameworks.Learning health systems · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe sustainability of healthcare delivery systems is challenged by ageing populations, complex systems, increasing rates of chronic disease, increasing costs associated with new medical technologies and growing expectations by healthcare consumers. Healthcare programmes, innovations and interventions are increasingly implemented at the front lines of care to increase effectiveness and efficiency; however, little is known about how sustainability is conceptualised and measured in programme evaluations.
objectivesWe aimed to describe theoretical frameworks, definitions and measures of sustainability, as applied in published evaluations of healthcare improvement programmes and interventions.
designSystematic integrative review.
methodsWe searched six academic databases, CINAHL, Embase, Ovid MEDLINE, Emerald Management, Scopus and Web of Science, for peer-reviewed English journal articles (July 2011-March 2018). Articles were included if they assessed programme sustainability or sustained outcomes of a programme at the healthcare system level. Six reviewers conducted the abstract and full-text review. Data were extracted on study characteristics, definitions, terminology, theoretical frameworks, methods and tools. Hawker's Quality Assessment Tool was applied to included studies.
resultsOf the 92 included studies, 75.0% were classified as high quality. Twenty-seven (29.3%) studies provided 32 different definitions of sustainability. Terms used interchangeably for sustainability included continuation, maintenance, follow-up or long term. Eighty studies (87.0%) clearly reported the timepoints at which sustainability was evaluated: 43.0% at 1-2 years and 11.3% at <12 months. Eighteen studies (19.6%) used a theoretical framework to conceptualise or assess programme sustainability, including frameworks that were not specifically designed to assess sustainability.
conclusionsThe body of literature is limited by the use of inconsistent definitions and measures of programme sustainability. Evaluations of service improvement programmes and interventions seldom used theoretical frameworks. Embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigour of programme sustainability evaluations.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.