ArticleImplementation science communications2023
Unpacking the 'process of sustaining'-identifying threats to sustainability and the strategies used to address them: a longitudinal multiple case study.
Article in Implementation science communications, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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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.
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Who cites it
9 citing papers in PubMed.
- A new way of thinking? Exploring professionals' perspectives on the sustainability of interprofessional team meetings: A focus group study.The European journal of general practice · 2026Article
- Driving Advice Documentation in Patient Notes and Discharge Summaries in Cardiology Patients.Cureus · 2026Article
- Sustaining a Promising Clinical Practice in High-Turnover Rural Environments Through the Geriatric Referral Navigator Role: Qualitative Case Study.JMIR formative research · 2026Article
- Sustainability through funding and leadership: a mixed-methods study of tobacco treatment programs across U.S. National Cancer Institute-designated Cancer Centers.Implementation science communications · 2026Article
- Staff perspectives on a novel pediatric developmental screening and referral program in a community health center.Frontiers in pediatrics · 2026Article
- Staff motivation and schools' capacities to sustain an intervention to prevent bullying and promote wellbeing in English secondary schools: a qualitative study.Frontiers in public health · 2025Article
- Improving access to first-line treatment for pediatric obesity: Lessons from the dissemination of SmartMoves.Obesity (Silver Spring, Md.) · 2024Article
- Role of coproduction in the sustainability of innovations in applied health and social care research: a scoping review.BMJ open quality · 2024Article
- Sustaining Quality Improvement to Increase Adverse Childhood Experience Questionnaire Response Rates and Proposal of Plan-do-study-act-assess Cycle.Pediatric quality & safetyArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough sustainability remains a recognised challenge for Quality Improvement (QI) initiatives, most available research continues to investigate sustainability at the end of implementation. As a result, the learning and continuous adjustments that shape sustainability outcomes are lost. With little understanding of the actions and processes that influence sustainability within QI initiatives, there is limited practical guidance and direction on how to enhance the sustainability of QI initiatives. This study aims to unpack the 'process of sustaining', by exploring threats to sustainability encountered throughout the implementation of QI Initiatives and identifying strategies used by QI teams to address these threats over time.
methodsA longitudinal multiple case study design was employed to follow 4 QI initiatives over a 3-year period. A standardised sustainability tool was used quarterly to collect perceptions of sustainability threats and actions throughout implementation. Interviews (n=38), observations (32.5 h), documentary analysis, and a focus group (n=10) were conducted to enable a greater understanding of how the process of sustaining is supported in practice. Data were analysed using the Consolidated Framework for Sustainability (CFS) to conduct thematic analysis.
resultsAnalysis identified five common threats to sustainability: workforce stability, improvement timelines, organisational priorities, capacity for improvement, and stakeholder support. Each of these threats impacted multiple sustainability constructs demonstrating the complexity of the issues encountered. In response to threats, 12 strategies to support the process of sustaining were identified under three themes: engagement (five strategies that promoted the development of relationships), integration (three strategies that supported initiatives to become embedded within local systems), and adaptation (four strategies that enhanced understanding of, and response to, emergent conditions and contextual needs).
conclusionsSustaining improvements from QI initiatives requires continuous investment in relationships, resilience to integrate improvements in local systems, and flexibility to understand emergent conditions. Findings provide practitioners, funders, and researchers with a better understanding of, and preparation for, the threats associated with sustaining improvements from QI initiatives and offer insight into specific actions that can be taken to mitigate these risks. This learning can be used to inform future initiative design and support, to optimise the sustainability of healthcare improvements.
trial registrationNot applicable.
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