Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

Nathan, Nicole; Shelton, Rachel C.; Laur, Celia; Hailemariam, Maji; Hall, Alix

doi:10.3389/frhs.2023.1176023

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…56,57 Similarly, sustaining change requires ongoing efforts. The finding that audit/feedback and education were the most common strategies in the present review aligns with existing organisational change and sustainability literature, 58,59 and while these strategies are essential, they are rarely sufficient in isolation to improve the quality of healthcare. 58,60 Furthermore, how and if these strategies change from initial implementation to supporting sustainability is unknown.…”

Section: Outcomes Of Sustainabilitysupporting

confidence: 83%

“…60 Strong leadership, multidisciplinary stakeholder engagement, team communication and a learning culture that embraces change were identified as important enablers by included studies, consistent with sustainability of other EBIs. 59 It has been suggested that sustainability of a programme is dependent on its acceptability, fidelity and feasibility, 61 Sustainability is most often conceptualised as the continuation of intervention activities. 15 Findings from the present review suggest that a strength of the ERAS literature is that it tends to report protocol adherence alongside patient and/or service delivery outcomes, albeit inconsistently.…”

Section: Outcomes Of Sustainabilitymentioning

confidence: 99%

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Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

Byrnes,

Flynn,

Watt

et al. 2023

Evaluation Clinical Practice

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BackgroundEnhanced Recovery After Surgery (ERAS) is an evidence‐based intervention that is well‐recognised across multiple surgical specialties as having potential to lead to improved patient and hospital outcomes. Little is known about sustainability of ERAS programmes.AimsThis review aimed to describe available evidence evaluating sustainability of ERAS programmes in gastrointestinal surgery to understand: (a) how sustainability has been defined; (b) examine determinants of sustainability; (c) identify strategies used to facilitate sustainability; (d) identify adaptations to support sustainability; and (e) examine outcomes measured as indicators of sustainability of ERAS programmes.MethodsThis scoping review was conducted following the Joanna Briggs Institute's methodology. Research databases (PubMed, Embase, CINHAL) and the grey literature were searched (inception to September 2022) for studies reporting sustainability of ERAS programmes in gastrointestinal surgery. Included articles reported an aspect of sustainability (i.e., definition, determinants, strategies, adaptations, outcomes and ongoing use) at ≥2 years following initial implementation. Aspects of sustainability were categorised according to relevant frameworks to facilitate synthesis.ResultsThe search strategy yielded 1852 records; first round screening excluded 1749, leaving 103 articles for full text review. Overall, 22 studies were included in this review. Sustainability was poorly conceptualised and inconsistently reported across included studies. Provision of adequate resources was the most frequently identified enabler to sustainability (n/N = 9/12, 75%); however, relatively few studies (n = 4) provided a robust report of determinants, with no study reporting determinants of sustainability and strategies and adaptations to support sustainability alongside patient and service delivery outcomes.ConclusionImproved reporting, particularly of strategies and adaptations to support sustainability is needed. Refinement of ERAS reporting guidelines should be made to facilitate this, and future implementation studies should plan to document and report changes in context and corresponding programme changes to help researchers and clinicians sustain ERAS programmes locally.

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Section: Outcomes Of Sustainabilitysupporting

confidence: 83%

Section: Outcomes Of Sustainabilitymentioning

confidence: 99%

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

Byrnes,

Flynn,

Watt

et al. 2023

Evaluation Clinical Practice

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“…The implementation of EBIs to improve healthcare does not always result in their long-term use or continued benefit for patients or health systems [ 33 ]. This gap illustrates the need to examine EBI sustainability as a separate phenomenon [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…89). Over the last decade, less than 1% of research has focused on the sustainability of EBIs for healthcare [ 4 , 33 , 34 ]. One challenge with sustainability research has been the variation in its conceptualization resulting in operationalization and measurement challenges.…”

Section: Introductionmentioning

confidence: 99%

Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review

Flynn,

Cassidy,

Dobson

et al. 2023

Implementation Sci

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Background Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. Objectives This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). Methods We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.’s measures, and EBI sustainability outcomes using Scheirer and Dearing’s and Lennox’s taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. Results The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). Conclusions Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.

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“…Such partners are critical to engage to understand the long-term use, needed resources, and ongoing improvements and adaptations of EBIs over time ( 27 ). Successfully sustaining EBIs focused on reducing health inequities requires engaging a range of key partners throughout the planning, implementation, and adaptation process to increase the fit between EBIs and local context/resources, while also addressing dynamic and emerging issues that might impede sustainability ( 14 , 16 , 22 ). Establishing processes to facilitate ongoing and meaningful engagement with key partners in the setting where EBIs are deployed is essential to managing and supporting the sustainability of an EBI within a changing context.…”

Section: Challenges and Considerations In Promoting Sustainability An...mentioning

confidence: 99%

Making the connection between health equity and sustainability

Shelton,

Hailemariam,

Iwelunmor

2023

Front. Public Health

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Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.

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Editorial: Sustaining the implementation of evidence-based interventions in clinical and community settings

Cited by 11 publications

References 13 publications

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review

Making the connection between health equity and sustainability

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