title: Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.
abstract: The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study indicates the SM provides a potentially useful approach to measuring teams' views on the likelihood of sustainability and prompting action. Securing engagement of teams with the SM was challenging and redesign of elements may need to be considered. Capacity building and facilitation appears necessary for teams to effectively deploy the SM.
authors.affiliation: NIHR CLAHRC for Northwest London, 4th Floor Lift Bank D, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. c.doyle@imperial.ac.uk.
authors.forename: Cathal
authors.initials: C
authors.lastname: Doyle
authors.forename: Cathy
authors.initials: C
authors.lastname: Howe
authors.forename: Thomas
authors.initials: T
authors.lastname: Woodcock
authors.forename: Rowan
authors.initials: R
authors.lastname: Myron
authors.forename: Karen
authors.initials: K
authors.lastname: Phekoo
authors.forename: Chris
authors.initials: C
authors.lastname: McNicholas
authors.forename: Jessica
authors.initials: J
authors.lastname: Saffer
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
mesh_terms: D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006779:Hospitals, Public; D017146:Models, Organizational; D010348:Patient Care Team; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement; D013222:State Medicine; D006113:United Kingdom