The Clinical Sustainability Assessment Tool: Measuring Organizational Capacity to Promote Sustainability in Healthcare

Abstract

Background Few validated assessment tools are available to support sustainable implementation, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool, or CSAT, designed to assess factors that contribute to sustainable practices in clinical settings. Methods Fifty participants from clinical and research fields were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted remaining factors based on similarity. Using concept mapping analyses, we grouped these factors into meaningful domains and developed an initial tool. We then recruited 126 practicing clinicians to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric (53%) and adult (47%) medical and surgical subspecialties, and averaged 11 years in their position. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains.Results The concept mapping resulted in seven domains and 47 items. The pilot and CFA resulted in 35 items, five per domain. The RMSEA of 0.084 and the SRMR of 0.075 indicated good fit. The final domains were: engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness. Conclusions The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time. The full CSAT instrument is available at https://sustaintool.org.

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“…Given the preliminary stage, we will not collect costs, which is a third component of implementation outcomes under RE-AIM. Maintenance will be assessed at the provider ( 96 – 98 ) and clinic levels ( 99 , 100 ) to understand the potential for sustained use and identify barriers (e.g., organizational, financial, regulatory factors) that may influence sustainability. Early phase implementation data will be used to develop an implementation strategy package that will be tested in later-phase effectiveness-implementation trials (ORBIT Phase III-IV) to enhance the adoption, implementation, local adaptation, and sustainability of PREVENT ( 101 ).…”

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“…This study responded to calls to describe the process of sustainability planning 18,40,56 and IKT. 80,81 We identified how the implementation teams collaborated to successfully plan for sustainability, reported the sustainability plan and described the necessity of iterative sustainability planning.…”

“…The CSAT is composed of 35 items divided between seven subscales, on a seven‐point Likert scale. During its recent development ( n = 126) its authors assessed the CSAT's structural validity (RMSEA = 0.084, SRMR = 0.075, CFI = 0.81) and internal consistency (Cronbach's α = 0.82–0.94) in varied clinical settings 56 . The CSAT helped us identify barriers and prompt sustainability planning at each site (Supporting Information Appendix ).…”

“…During its recent development (n = 126) its authors assessed the CSAT's structural validity (RMSEA = 0.084, SRMR = 0.075, CFI = 0.81) and internal consistency (Cronbach's α = 0.82-0.94) in varied clinical settings. 56 The CSAT helped us identify barriers and prompt sustainability planning at each site (Supporting Information Appendix C). or were invited to join the MPAI-4 implementation team by the lead researcher and manager at each site because their expertise was important for implementation success.…”

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