title: After adoption: sustaining the innovation. A case study of disseminating the hospital elder life program.
abstract: 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.
authors.affiliation: Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut 06520, USA. elizabeth.bradley@yale.edu
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Tashonna R
authors.initials: TR
authors.lastname: Webster
authors.forename: Dorothy
authors.initials: D
authors.lastname: Baker
authors.forename: Mark
authors.initials: M
authors.lastname: Schlesinger
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: 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