title: Measuring sustainability within the Veterans Administration Mental Health System Redesign initiative.
abstract: OBJECTIVE
  To examine how attributes affecting sustainability differ across Veterans Health Administration organizational components and by staff characteristics.
  
  
  METHODS
  Surveys of 870 change team members and 50 staff interviews within the Veterans Affairs' Mental Health System Redesign initiative.
  
  
  METHODS
  A 1-way ANOVA with a Tukey post hoc test examined differences in sustainability by Veteran Integrated Service Networks, job classification, and tenure from staff survey data of the Sustainability Index. Qualitative interviews used an iterative process to identify "a priori" and "in vivo" themes. A simple stepwise linear regression explored predictors of sustainability.
  
  
  RESULTS
  Sustainability differed across Veteran Integrated Service Networks and staff tenure. Job classification differences existed for the following: (1) benefits and credibility of the change and (2) staff involvement and attitudes toward change. Sustainability barriers were staff and institutional resistance and nonsupportive leadership. Facilitators were commitment to veterans, strong leadership, and use of quality improvement tools. Sustainability predictors were outcomes tracking, regular reporting, and use of Plan, Do, Study, Adjust cycles.
  
  
  CONCLUSIONS
  Creating homogeneous implementation and sustainability processes across a national health system is difficult. Despite the Veterans Affairs' best evidence-based implementation efforts, there was significant variance. Locally tailored interventions might better support sustainability than "one-size-fits-all" approaches. Further research is needed to understand how participation in a quality improvement collaborative affects sustainability.
authors.affiliation: Center for Health Enhancement System Studies, University of Wisconsin, Madison, Wisconsin 53706, USA. jay.ford@chess.wisc.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Ford
authors.forename: Dean
authors.initials: D
authors.lastname: Krahn
authors.forename: Meg
authors.initials: M
authors.lastname: Wise
authors.forename: Karen Anderson
authors.initials: KA
authors.lastname: Oliver
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D009790:Occupations; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*