Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare

Abstract

BackgroundImprovement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and necessary changes to patient care and outcomes. However, many improvement initiatives fail to sustain to a point where their full benefits can be realised. This has led many researchers and healthcare practitioners to develop frameworks, models and tools to support and monitor sustainability. This work aimed to identify what approaches are available to assess and influence sustainability in healthcare and to describe the different perspectives, applications and constructs within these approaches to guide their future use.MethodsA systematic review was carried out following PRISMA guidelines to identify publications that reported approaches to support or influence sustainability in healthcare. Eligibility criteria were defined through an iterative process in which two reviewers independently assessed 20% of articles to test the objectivity of the selection criteria. Data were extracted from the identified articles, and a template analysis was undertaken to identify and assess the sustainability constructs within each reported approach.ResultsThe search strategy identified 1748 publications with 227 articles retrieved in full text for full documentary analysis. In total, 62 publications identifying a sustainability approach were included in this review (32 frameworks, 16 models, 8 tools, 4 strategies, 1 checklist and 1 process). Constructs across approaches were compared and 40 individual constructs for sustainability were found. Comparison across approaches demonstrated consistent constructs were seen regardless of proposed interventions, setting or level of application with 6 constructs included in 75% of the approaches. Although similarities were found, no approaches contained the same combination of the constructs nor did any single approach capture all identified constructs. From these results, a consolidated framework for sustainability constructs in healthcare was developed.ConclusionsChoosing a sustainability method can pose a challenge because of the diverse approaches reported in the literature. This review provides a valuable resource to researchers, healthcare professionals and improvement practitioners by providing a summary of available sustainability approaches and their characteristics.Trial registrationThis review was registered on the PROSPERO database: CRD42016040081 in June 2016.Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0707-4) contains supplementary material, which is available to authorized users.

Defining sustainability in practice: views from implementing real-world innovations in health care

“…We found they define sustainability in terms of three concepts: continued capacity to deliver the innovation, continued delivery of the innovation, and continued receipt of benefits. These concepts align well with the academic literature on this topic [18,[43][44][45]. At the same time, participants provided a nuanced view of these concepts, with both continued delivery and continued benefits only relevant under certain conditions.…”

“…Several authors have recently shown the most common definition of sustainability is the continuation or maintenance of an innovation or its activities [18,43]. Interestingly, the most prevalent element of sustainability discussed in this study was continued capacity, which was not integrated in Moore et al's recent comprehensive definition [18].…”

“…Finally, participants defined sustainability using both process and outcome concepts and language. In both conceptual and empirical work, sustainability is most often viewed as an outcome with innovation components/activities, benefits, and/or capacity maintained [18,43,44], although recent authors have included the ability to adapt and continually improve as important to a sustainability definition [18,34]. Defining sustainability as an outcome may very well aid monitoring and evaluation [32], yet this view may fail to capture the iterative and dynamic nature of sustainability (proposed by Chambers [34]) and highlighted by participants in this study), including the need to continuously monitor, learn, adapt, and improve [34] and the socio-technical character of implementation or health care in general [51,52].…”

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

“…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. For studies focused solely on studying determinants or outcomes of sustainability, we suggest that researchers utilize models and frameworks focused explicitly on exploring the dynamics of sustainability [53,54].…”

Obstacles to use of patient expertise to improve care: a co-produced longitudinal study of the experiences of young people with sickle cell disease in non-specialist hospital settings

“…Patient and public involvement (PPI) initiatives often try to amplify patient voices in healthcare settings (for example in the UK, NHS Shared Decision Making, 2017; National Institute for Health and Care Excellence [NICE], 2016), including through co-production, in which patients and the public work with healthcare providers to improve services . Achieving and sustaining healthcare co-production is of interest to healthcare policy makers, clinicians and researchers (Gruen et al, 2008;Lennox, Maher, & Reed, 2018), and has the potential to generate 'meaningful ways of shaping and taking part in health care' (Filipe et al, 2017, p. 2). This might take the form of shared decision making with patients (NHS, 2017), or developing patient-centred services in hospitals and clinics (Robert et al, 2015).…”