title: Sustaining clinical programs during difficult economic times: a case series from the Hospital Elder Life Program.
abstract: OBJECTIVE
  To explore strategies used by clinical programs to justify operations to decision-makers using the example of the Hospital Elder Life Program (HELP), an evidence-based, cost-effective program to improve care for hospitalized older adults.
  
  
  METHODS
  Qualitative study design using 62 in-depth, semistructured interviews conducted with HELP staff members and hospital administrators between September 2008 and August 2009.
  
  
  METHODS
  Nineteen HELP sites in hospitals across the United States and Canada that had been recruiting patients for at least 6 months.
  
  
  METHODS
  HELP staff and hospital administrators.
  
  
  METHODS
  Participant experiences sustaining the program in the face of actual or perceived financial threats, with a focus on factors they believe are effective in justifying the program to decision-makers in the hospital or health system.
  
  
  RESULTS
  Using the constant comparative method, a standard qualitative analysis technique, three major themes were identified across interviews. Each focuses on a strategy for successfully justifying the program and securing funds for continued operations: interact meaningfully with decision-makers, including formal presentations that showcase operational successes and informal means that highlight the benefits of HELP to the hospital or health system; document day-to-day, operational successes in metrics that resonate with decision-maker priorities; and garner support from influential hospital staff that feed into administrative decision-making, particularly nurses and physicians.
  
  
  CONCLUSIONS
  As clinical programs face financially challenging times, it is important to find effective ways to justify their operations to decision-makers. Strategies described here may help clinically effective and cost-effective programs sustain themselves and thus may help improve care in their institutions.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts 02115, USA. gsteel@hsph.harvard.edu
authors.forename: Gillian K
authors.initials: GK
authors.lastname: SteelFisher
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Martin
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Dowal
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: D000368:Aged; D002170:Canada; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D003299:Cooperative Behavior; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D019317:Evidence-Based Medicine / Q000191:economics; D005376:Financial Management / Q000458:organization & administration; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics* / Q000458:organization & administration*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D033183:Interdisciplinary Communication; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration; D006278:Medicare / Q000191:economics; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D014481:United States
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