After adoption: sustaining the innovation. A case study of disseminating the hospital elder life program.
OBJECTIVE
To examine key factors that influence sustainability in the diffusion of the Hospital Elder Life Program (HELP) as an example of an evidence-based, multifaceted, innovative program to improve care for hospitalized older adults.


METHODS
Longitudinal, qualitative study between November 2000 and November 2003 based on 102 in-depth interviews every 6 months during HELP implementation.


METHODS
Thirteen hospitals implementing HELP.


METHODS
Forty-two hospital staff members (physician, nursing, volunteer, and administrative staff) implementing HELP, conducted 102 interviews.


METHODS
Staff experiences sustaining the program, including challenges and strategies that they viewed as successful in addressing these challenges.


RESULTS
Of the 13 hospitals studied, 10 were sustaining HELP at the end of the study period; three terminated the program (after 24 months, 12 months, and 6 months). Critical factors were identified as influencing whether the program was sustained: the presence of clinical leadership, the ability and willingness to adapt the original HELP protocols to local hospital circumstances and constraints, and the ability to obtain longer-term resources and funding for HELP.


CONCLUSIONS
Recognizing the need for sustained clinical leadership and funding as well as the inevitable modifications required to sustain innovative programs can promote more-realistic goals and expectations for health services researchers, clinicians, and policy makers in their laudable efforts to translate research into practice.
Bradley
Elizabeth H
EH
Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut 06520, USA. elizabeth.bradley@yale.edu
Webster
Tashonna R
TR
Baker
Dorothy
D
Schlesinger
Mark
M
Inouye
Sharon K
SK
D000368:Aged; D003625:Data Collection; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D008137:Longitudinal Studies; D014481:United States