Developing a comprehensive definition of sustainability

Moore, Julia E.; Mascarenhas, Alekhya; Bain, Julie; Straus, Sharon E.

doi:10.1186/s13012-017-0637-1

Cited by 424 publications

(425 citation statements)

References 36 publications

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“…37 Guidelines on institutionalization of equity-focused change initiatives need to include specific strategies for rollout, diffusion, and sustainability. 65…”

Section: Discussionmentioning

confidence: 99%

The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review

Spitzer-Shohat

Chin

2019

J GEN INTERN MED

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BACKGROUND: Different conceptual frameworks guide how an organization can change its policies and practices to make care and outcomes more equitable for patients, and how the organization itself can become more equitable. Nonetheless, healthcare organizations often struggle with implementing these frameworks. OBJECTIVE: To assess what guidance frameworks for health equity provide for organizations implementing interventions to make care and outcomes more equitable. STUDY DESIGN: Fourteen inequity frameworks from scoping literature review 2000-2017 that provided models for improving disparities in quality of care or outcomes were assessed. We analyzed how frameworks addressed key implementation factors: (1) outer and inner organizational contexts; (2) process of translating and implementing equity interventions throughout organizations; (3) organizational and patient outcomes; and (4) sustainability of change over time. PARTICIPANTS: We conducted member check interviews with framework authors to verify our assessments. KEY RESULTS: Frameworks stressed assessing the organization's outer context, such as population served, for tailoring change strategies. Inner context, such as existing organizational culture or readiness for change, was often not addressed. Most frameworks did not provide guidance on translation of equity across multiple organizational departments and levels. Recommended evaluation metrics focused mainly on patient outcomes, leaving organizational measures unassessed. Sustainability was not addressed by most frameworks. CONCLUSIONS: Existing equity intervention frameworks often lack specific guidance for implementing organizational change. Future frameworks should assess inner organizational context to guide translation of programs across different organizational departments and levels and provide specific guidelines on institutionalization and sustainability of interventions.

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“…37 Guidelines on institutionalization of equity-focused change initiatives need to include specific strategies for rollout, diffusion, and sustainability. 65…”

Section: Discussionmentioning

confidence: 99%

The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review

Spitzer-Shohat

Chin

2019

J GEN INTERN MED

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“…Selecting a definition of sustainability can be challenging [37]. Most implementation studies do not include an operationalised definition of the term, and the existing definitions are inconsistent [38].…”

Section: Methodsmentioning

confidence: 99%

Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment

Bergmark¹,

Bejerholm²,

Svensson³

et al. 2018

International Journal of Integrated Care

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Introduction:There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative.Methods:Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The “Sustainable Implementation Scale” helped to identify critical implementation components, and these were further explored using the qualitative interview data. The “Tool for Measuring Assertive Community Treatment” addressed programme fidelity, and the initiative’s sustainability was assessed.Results:High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members’ characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model’s characteristics and existing organisational traditions and regulations.Discussion and Conclusions:Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.

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“…The construct of perceived sustainability is intended to capture the perceived likelihood of continued use of program components and activities for the continued achievement of desirable program and population outcomes [45]. Sustainability is a key implementation outcome, and definitions of sustainability vary in the implementation literature [51,52]. This construct, as presented, is intended to capture perceptions of sustainability at a health systems level throughout and after implementation, and not sustained behavior at an individual level.…”

Section: Description Of Newly Proposed Constructsmentioning

confidence: 99%

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

et al. 2020

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Background: The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that may require adaptation or contextualization to fit the needs of implementation scientists in low-and middleincome countries (LMICs). The purpose of this review is to characterize how the CFIR has been applied in LMIC contexts, to evaluate the utility of specific constructs to global implementation science research, and to identify opportunities to refine the CFIR to optimize utility in LMIC settings.Methods: A systematic literature review was performed to evaluate the use of the CFIR in LMICs. Citation searches were conducted in Medline, CINAHL, PsycINFO, CINAHL, SCOPUS, and Web of Science. Data abstraction included study location, study design, phase of implementation, manner of implementation (ex., data analysis), domains and constructs used, and justifications for use, among other variables. A standardized questionnaire was sent to the corresponding authors of included studies to determine which CFIR domains and constructs authors found to be compatible with use in LMICs and to solicit feedback regarding ways in which CFIR performance could be improved for use in LMICs.Results: Our database search yielded 504 articles, of which 34 met final inclusion criteria. The studies took place across 21 countries and focused on 18 different health topics. The studies primarily used qualitative study designs (68%). Over half (59%) of the studies applied the CFIR at study endline, primarily to guide data analysis or to contextualize study findings. Nineteen (59%) of the contacted authors participated in the survey. Authors unanimously identified culture and engaging as compatible with use in global implementation research. Only two constructs, patient needs and resources and individual stages of change were commonly identified as incompatible with use. Author feedback centered on team level influences on implementation, as well as systems characteristics, such as health system architecture. We propose a "Characteristics of Systems" domain and eleven novel constructs be added to the CFIR to increase its compatibility for use in LMICs. Conclusions: These additions provide global implementation science practitioners opportunities to account for systemslevel determinants operating independently of the implementing organization. Newly proposed constructs require further reliability and validity assessments. Trial registration: PROSPERO, CRD42018095762

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Developing a comprehensive definition of sustainability

Cited by 424 publications

References 36 publications

The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review

The “Waze” of Inequity Reduction Frameworks for Organizations: a Scoping Review

Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment

Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review

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