SynthesisImplementation science : IS2023
Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review.
Synthesis in Implementation science : IS, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers.
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
56 citing papers in PubMed.
- 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
- Sustainability of implementation of health-promotion practice in primary healthcare: a non-randomized parallel group study.BMC health services research · 2026Trial
- Effectiveness Evaluation of a Violence Prevention Parenting Program Implemented at Large Scale: A Randomized Controlled Trial.Psychosocial intervention · 2025Trial
- 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
- Integrating Sustainability into ISO 15189.Annals of laboratory medicine · 2026Article
- Sustainable Healthcare: A Perspective on the Current Landscape, Frameworks, Barriers, and Implementation Model in a Quaternary Hospital System.International journal of environmental research and public health · 2026Review
- Global Pathways to Thriving Children: Implementing Large-Scale Multicomponent Nutrition and Child Development Programs.The Journal of nutrition · 2026Article
- What Matters in Sustaining Peer Support for Adults in Mental Health Services? Exploring the Perceptions of Diverse Actors.Community mental health journal · 2026Article
- Beyond implementation: what drives long-term sustainment of life-sustaining treatment documentation in VA home based primary care.BMC health services research · 2026Article
- Implementation and impact: integrating a parenting intervention into routine care for children with early neurological conditions.Pediatric research · 2026Article
- Advancing Sustainable Healthcare in Obstetric and Maternity Nursing: Nurses' Knowledge, Awareness, and Clinical Practice-A Cross-Sectional Study.International journal of environmental research and public health · 2026Article
- Commissioners' views and experiences of implementing virtual wards in Integrated Care Systems in England: a longitudinal qualitative study using the Consolidated Framework for Implementation Research (CFIR).BMC health services research · 2026Article
- Managing urinary incontinence: evaluating the role of practice facilitators in enhancing quality improvement and digital integration in primary care.Implementation science communications · 2026Article
- Strategies to support implementation of infectious disease decision support systems: a scoping review.BMC medical informatics and decision making · 2026Article
- Core Elements of Goals of Care Initiatives Across Eight Health Systems.Journal of pain and symptom management · 2026Article
- Evaluating the sustainability of a three-year community-based intergenerational project in Hong Kong: a longitudinal mixed methods study from the perspective of service providers.Implementation science communications · 2026Article
- Enablers and barriers for using reusable trocars: a qualitative study of surgeons' and residents' perspectives.Surgical endoscopy · 2026Article
- Dietitians as System Builders: Advancing Equity, Sustainability and Health in Community Nutrition and Primary Care.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026Article
- Determinants of sustainable quality improvement for operating room clean air systems: a two-phase sequential qualitative study in Dutch hospitals.BMC health services research · 2026Article
- Designing for Accelerated Translation-Intervention (DART-I): adaptation, theoretical grounding, and formative evaluation in community care for evaluating implementation potential.BMC health services research · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
Abstract
objectiveTo identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. DATA SOURCES AND STUDY
settingSix academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability. STUDY
designA systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker's Quality Assessment Tool. DATA COLLECTION/EXTRACTION
methodsA team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies.
resultsOf the 124 studies included in this review, almost half utilised qualitative designs (n = 52; 41.9%) and roughly one third were conducted in the USA (n = 43; 34.7%). Few studies (n = 29; 23.4%) reported on program sustainability beyond 5 years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting (n = 99; 79.8%), process (n = 99; 79.8%) and intervention characteristics (n = 72; 58.1%) were most frequently reported. Leadership/support (n = 61; 49.2%), training/support/supervision (n = 54; 43.5%) and staffing/turnover (n = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding (n = 26; 56.5%), external leadership by stakeholders (n = 16; 34.8%), and socio-political context (n = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation.
conclusionsThis review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area.
trial registrationhttps://bmjopen.bmj.com/content/7/11/e018568 .
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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.