Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement

Abstract

The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL).Data from project teams’ responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as ‘engaged,’ ‘partially engaged’ and ‘non-engaged.’ Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a ‘diversity of opinion’ measure was derived to assess response variance over time.Of the 19 teams, six were categorized as ‘engaged,’ six ‘partially engaged,’ and seven as ‘non-engaged.’ Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness.The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study indicates the SM provides a potentially useful approach to measuring teams’ views on the likelihood of sustainability and prompting action. Securing engagement of teams with the SM was challenging and redesign of elements may need to be considered. Capacity building and facilitation appears necessary for teams to effectively deploy the SM.

Innovation and sustainability in a large-scale healthcare improvement collaborative - seven propositions for achieving system-wide innovation and sustainability

“…Within the context of current reforms and ever-complex healthcare issues that transcend organisational boundaries, the UK NHS is compelled to adapt to new ways of organising and operating in order to meet the unique demands placed upon it (Dhillon, 2013;Doyle et al, 2013). Significant change and reform in the UK Healthcare system has now necessitated a rethink from observers about the need for more innovation in this sector (Doyle et al, 2013).…”

“…Significant change and reform in the UK Healthcare system has now necessitated a rethink from observers about the need for more innovation in this sector (Doyle et al, 2013). This is evidenced through, for instance, the manner in which multi-organisational quality improvement collaborative networks are being proffered as a solution for improving quality within the healthcare sector (Dainty et al, 2013).…”

“…These include large-scale improvement collaborative, such as collaboration in leadership for applied health research and care (CLAHRC) (Baker et al, 2009;Hanbury et al, 2010;Harvey et al, 2011;Rowley et al, 2012;Doyle et al, 2013;Evans and Scarbrough, 2014), the LIQH (Mervyn and Amoo, 2014) and the new NHS 'Vanguards' (health system innovators), which are providing a test bed for the redesign of the NHS and deeper integration of services (Berry, 2015). The 29 Vanguard sites have been selected by the NHS in England, with a view to adopting new and enhanced models of integrated healthcare.…”

“…Therefore, innovation in health systems is increasingly being seen as a way to address some of these challenges (Doyle et al, 2013).…”

More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care

“…Gaps also exist regarding patient reported outcomes and how the unit context and climate potentially influences implementation. This knowledge is needed before dissemination of any innovation to improve nutrition care in hospital, including the INPAC is undertaken [47][48][49][50]. An observational study that monitors how sites implement INPAC, the educational techniques and strategies that are most successful, resource utilization and impacts on staff roles and patient reported outcomes would provide a substantial contribution to this field where implementation research is just beginning.…”