Lennox Laura, Antonacci Grazia, Harris Matthew, Reed Julie
National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) for Northwest London, 369 Fulham Road, London, SW10 9NH, UK.
Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
Implement Sci Commun. 2023 Jun 19;4(1):68. doi: 10.1186/s43058-023-00445-z.
Although sustainability remains a recognised challenge for Quality Improvement (QI) initiatives, most available research continues to investigate sustainability at the end of implementation. As a result, the learning and continuous adjustments that shape sustainability outcomes are lost. With little understanding of the actions and processes that influence sustainability within QI initiatives, there is limited practical guidance and direction on how to enhance the sustainability of QI initiatives. This study aims to unpack the 'process of sustaining', by exploring threats to sustainability encountered throughout the implementation of QI Initiatives and identifying strategies used by QI teams to address these threats over time.
A longitudinal multiple case study design was employed to follow 4 QI initiatives over a 3-year period. A standardised sustainability tool was used quarterly to collect perceptions of sustainability threats and actions throughout implementation. Interviews (n=38), observations (32.5 h), documentary analysis, and a focus group (n=10) were conducted to enable a greater understanding of how the process of sustaining is supported in practice. Data were analysed using the Consolidated Framework for Sustainability (CFS) to conduct thematic analysis.
Analysis identified five common threats to sustainability: workforce stability, improvement timelines, organisational priorities, capacity for improvement, and stakeholder support. Each of these threats impacted multiple sustainability constructs demonstrating the complexity of the issues encountered. In response to threats, 12 strategies to support the process of sustaining were identified under three themes: engagement (five strategies that promoted the development of relationships), integration (three strategies that supported initiatives to become embedded within local systems), and adaptation (four strategies that enhanced understanding of, and response to, emergent conditions and contextual needs).
Sustaining improvements from QI initiatives requires continuous investment in relationships, resilience to integrate improvements in local systems, and flexibility to understand emergent conditions. Findings provide practitioners, funders, and researchers with a better understanding of, and preparation for, the threats associated with sustaining improvements from QI initiatives and offer insight into specific actions that can be taken to mitigate these risks. This learning can be used to inform future initiative design and support, to optimise the sustainability of healthcare improvements.
Not applicable.
尽管可持续性仍然是质量改进（QI）举措面临的一个公认挑战，但大多数现有研究仍在实施结束时调查可持续性。因此，塑造可持续性结果的学习和持续调整就丢失了。由于对质量改进举措中影响可持续性的行动和过程了解甚少，关于如何提高质量改进举措的可持续性的实际指导和方向有限。本研究旨在通过探索质量改进举措实施过程中遇到的可持续性威胁，并确定质量改进团队随着时间推移应对这些威胁所采用的策略，来剖析“维持过程”。
采用纵向多案例研究设计，在3年时间内跟踪4项质量改进举措。每季度使用标准化的可持续性工具收集对可持续性威胁和整个实施过程中的行动的看法。进行了访谈（n = 38）、观察（32.5小时）、文献分析和焦点小组（n = 10），以便更好地了解在实践中如何支持维持过程。使用可持续性综合框架（CFS）对数据进行分析，以进行主题分析。
分析确定了对可持续性的五个常见威胁：劳动力稳定性、改进时间表、组织优先事项、改进能力和利益相关者支持。这些威胁中的每一个都影响了多个可持续性结构，表明所遇到问题的复杂性。作为对威胁的回应，在三个主题下确定了12项支持维持过程的策略：参与（五项促进关系发展的策略）、整合（三项支持举措融入当地系统的策略）和适应（四项增强对新出现情况和背景需求的理解及应对能力的策略）。
维持质量改进举措带来的改进需要在关系上持续投入、具备将改进融入当地系统的适应能力以及理解新出现情况的灵活性。研究结果使从业者、资助者和研究人员更好地理解与维持质量改进举措带来的改进相关的威胁并做好准备，并深入了解可以采取哪些具体行动来降低这些风险。这些经验教训可用于为未来的举措设计和支持提供信息，以优化医疗保健改进的可持续性。
不适用。
