The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review

Abstract

Background: Identifying factors that influence sustained implementation of hospital-based interventions is key to ensuring evidence-based best practice is maintained across the NHS. This study aimed to identify, appraise and synthesise the barriers and facilitators that influenced the delivery of sustained healthcare interventions in a hospital-based setting. Methods: A systematic review reported in accordance with PRISMA. Eight electronic databases were reviewed in addition to a hand search of Implementation Science journal and reference lists of included articles. Two reviewers were used to screen potential abstracts and full text papers against a selection criteria. Study quality was also independently assessed by two reviewers. Barriers and facilitators were extracted and mapped to a consolidated sustainability framework. Results: Our searching identified 154,757 records. We screened 14,626 abstracts and retrieved 431 full text papers, of which 32 studies met the selection criteria. The majority of studies employed a qualitative design (23/32) and were conducted in the UK (8/32) and the USA (8/32). Interventions or programmes were all multicomponent, with the majority aimed at improving the quality of patient care and/ or safety (22/32). Sustainability was inconsistently reported across 30 studies. Barriers and facilitators were reported in all studies. The key facilitators included a clear accountability of roles and responsibilities (23/32); ensuring the availability of strong leadership and champions advocating the use of the intervention (22/32), and provision of adequate support available at an organisational level (21/32). The most frequently reported barrier to sustainability was inadequate staff resourcing (15/32). Our review also identified the importance of inwards spread and development of the initiative over time, as well as the unpredictability of sustainability and the need for multifaceted approaches. Conclusions: This review has important implications for practice and research as it increases understanding of the factors that faciliate and hinder intervention sustainability. It also highlights the need for more consistent and complete reporting of sustainability to ensure that lessons learned can be of direct benefit to future implementation of interventions. Trial registration: The review is registered on PROSPERO (CRD42017081992).

Barriers and facilitators to implementing the CURE stop smoking project: a qualitative study

“…The present findings give insight into how this process occurs, suggesting champions facilitate knowledge exchange and influence changes to professional identity that are needed for the system-wide cultural shift CURE aims to achieve. Some of the reported factors within the present study, such as competing priorities, resource availability and training opportunities, are commonly identified as challenges to intervention implementation within secondary care settings [33,34]. However, this study also highlights the importance of less commonly discussed factors on health professional behaviour.…”

Perceived sustainability of the school-based social and behavior change communication (SBCC) approach on malaria prevention in rural Ethiopia: stakeholders’ perspectives

“…Furthermore, confusion in the roles and responsibilities about “who should do what” and “who should owe the program” were identified as barriers to sustainability in this study. Having clear accountability of roles and responsibilities were reported as key facilitators influencing the sustainability of hospital-based interventions according to a recent systematic review [ 57 ]. Sustainability depends not only on the capabilities of the schools to implement the program, nor the resources and material supports; but also on the targeted community’s involvement and a building sense of ownership [ 58 ].…”

Late-afternoon communication and patient planning (CAPP) rounds: an intervention to allow early patient discharges

“…Third, we do not have information regarding changes in patient, physician and nurse satisfaction with the discharge process during the interventions. However, the clarity of roles and responsibilities created by Night CAPP rounds could be important for staff satisfaction which is ultimately can lead to long-term sustainability [17,18].…”