The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare

Abstract

Background Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to assess factors that contribute to sustainable practices in clinical settings. Methods Sixty-four participants from clinical and research fields participated in concept mapping and were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted items based on similarity and rated them by importance and feasibility. Using concept mapping analyses, items were grouped into meaningful domains to develop an initial tool. We then recruited pilot sites and early adopters, for a total of 286 practicing clinicians, to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric and adult medical and surgical subspecialties. 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 produced sorted statements that were edited into items that could be responded to, resulting in the creation of a tool with seven determinant domains and 47 items. The pilot and CFA testing resulted in a final CSAT instrument made up 35 items, five per domain. CFA results demonstrated very good fit of the seven domain structure of the CSAT (RMSEA = 0.049; SRMR = 0.049). Usability testing indicated the CSAT is brief, easy to use, easy to learn, and does not require extensive training. Additionally, the measure scored highly (18/20) on the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The seven final CSAT 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.

Sustainment of a complex culturally competent care intervention for Hispanic living donor kidney transplantation: A longitudinal analysis of adaptations

“…While the conceptualization of sustainment continues to evolve, most frameworks and models include multiple dimensions thought to be related to, or necessary for, ongoing intervention delivery over multiple years [2,10,15]. One commonality is intervention adaptation.…”

“…Doing so would likely necessitate a more frequent evaluation that could capture the dynamics of adaptation, as well as the use of other implementation strategies, using tools such as the Longitudinal Implementation Strategy Tracking System [44,45]. Last, contemporary models of implementation sustainment are multidimensional and include factors such as funding, leadership support, organizational capacity, and workflow integration, among others [5,15]. Our primary focus on adaptations, while rigorous, is but one contributor to sustainment.…”

“…Examining sustainment can help predict and increase the likelihood of long-term EBI delivery [8,10,11]. Factors contributing to sustainment include less intervention complexity (e.g., smaller number of interacting components) [12], ample funding and available resources (e.g., staff, time), and ability to adapt intervention components [3,[13][14][15]. The few studies examining reasons for intervention adaptations reported enhancing engagement in the intervention, reaching specific audiences, and increasing intervention fit to the institution [16,17].…”

Designing for Dissemination and Sustainability to Promote Equitable Impacts on Health

“…However, many evidence-based programs and policies are not sustained after initial implementation, wasting large amounts of financial, organizational, and social capital ( 60 ). Fortunately, new work has started making the case for more systematic study of sustainability, including conceptual development ( 35 , 148 ), method development ( 94 , 100 , 128 ), and applications to various health disciplines, such as public health, mental health, and health care delivery systems ( 19 ). An important audience to consider when designing for sustainability is policy makers—those who make decisions at both local or organizational levels (small p policy) and national or international levels (big P policy) about how and by whom public health and health care should be delivered and financed ( 23 ).…”

Development of a Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions in Primary Care Clinics

“…A goal of this work was to integrate implementation science and practice, so the tools we suggested needed to be practical for real-world settings. To address this challenge, we replaced references to ORC, ORIC, and ORCA with the Clinical Sustainability Assessment Tool ( 31 ) and the R = MC 2 readiness building framework ( 17 ). These instruments both measure CDC-required domains and are tools with which some recipients were familiar.…”