Table 4 Benefits and challenges reported for individual approaches
From: Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review
Sustainability approach | Benefits | Challenges |
|---|---|---|
1. Normalisation process theory | • Aided users to expose the ‘hidden work’ that needs to occur to create health-promoting systems • Created understanding of the barriers to implementation and identified potential strategies to address barriers • Provided framework to organise findings • Facilitated analysis of implementation from multiple perspectives and understanding of experiences of healthcare workers at the individual and organisational level • Drawing planners’ attention to potential problems to address during implementation | • Further development needed to link constructs to specific behaviour-change techniques • Overlap and difficulty of discerning the difference between the constructs • Based on perceptions of individual users; therefore, risk of bias and leaving some contextual factors beyond the scope of knowledge |
2. Normalisation process model | • Allowed the identification of barriers and facilitators impacting the programme • Provided framework to organise findings • Facilitated a deeper and more dynamic analysis | • Difficult to assign to a single category to the data as categories overlap |
3. Level of institutionalisation scale | • Allowed an aspect of continuous evaluation by measuring whether intervention is becoming institutionalised • Provided insight on implementation problems in routine settings • Enabled exploration of programme sustainability at different levels of care • Identified risks and barriers to sustainability | • More work is needed to test with larger samples and different health promotion programmes • Does not measure the processes leading to institutionalisation, only whether structural components are present or not present • Wording and response options may need to be modified to fit with specific contexts |
4. The advancing research and clinical practice through close collaboration model | • Improved outcomes of believing in the value of evidence-based practice and increased reported use of evidence-based practice implementation behaviours • Led to positive effects on nurses’ perceptions of organisational culture and readiness, beliefs and implementation, job satisfaction, group cohesion | • The model should include a cost component and patient outcomes to evaluate potential savings |
5. Program sustainability assessment tool | • Provided an overview of sustainability strengths and weaknesses • Determined programme elements intended to sustain for the long term • Enabled team to demonstrate accomplishments, tell their story, and build connections • Facilitated the development of a vision and mission for the programme | • The brevity and simplicity of the tool may not capture the nuances of the setting and situation |
6. Program sustainability index | • Provided evidence of the supporting role of effective collaborations in sustainment across different service systems • Provided a form of measurement | • Scales may require adaptation for use |
7. NHS III sustainability model | • Created an understanding of determinants of sustainability • Found to be relevant for examining implementation processes across a range of clinical settings | • Aspects of the model’s design should be considered to include more user-friendly design • Needs greater emphasis on the political and economic environment as well as patient and public engagement |
8. Slaghuis’s framework and instrument for sustainability | • Highlighted that strong relationships connect partnership functioning, synergy and the sustainability of innovative programmes in community care • Identified short and long-term improvements in quality of chronic care delivery predicted programme sustainability | • Lack of relevance of specific subscales |
9. Shell’s capacity for sustainability framework | • Highlighted key strengths and weaknesses as well as levers within programmes | • Some domains need further conceptual refinement • Hard to categorise domains as entirely positive or negative due to the many nuances involved |
10. Leffer’s conceptual framework for partnership and sustainability | • Provided the structure for deeper understanding of distinctive views regarding the engagement processes and partner factors for effective collaboration • Model constructs offered a platform to engage in dialogue with partners to gain context-specific insights • Useful in guiding study to examine global health partnerships | • Model did not explore nurse partner factors, resources or sustainability; therefore, applicability of the model with other host partners, professions and contexts needs to be investigated • Not generalisable to other countries outside of the United States |
11. Gruen’s model of health-programme sustainability | • Provided greater insight into the sustainability of interventions • Provided insight into issues affecting programme sustainability and may foster development of a sustainability plan | • Not stated |
12. Fleiszer’s framework for the sustainability of healthcare innovations | • Aided in the identification of characteristics of programme sustainability | • May benefit from further investigation to examine the long-term sustainability and discontinuation of different kinds of innovations in diverse settings |
13. The sustainability analysis process | • Supported participants to clarify the boundaries of their systems, define sustainability and identify sustainability indicators | • Not stated |
14. Conceptual framework for planning for sustainability of community-based health programs | • Considered useful for analysis • Provided an understanding of how programme sustainability is impacted by different components in and out of the community | • Framework could not address cultural specificity |
15. Atun’s conceptual framework for analysing integration | • Provided a systems lens for increasing integration and how this can help sustain effective interventions | • Not stated |
16. Practical, robust implementation and sustainability model | • Provided valuable data that helped develop a detailed implementation plan and facilitated the implementation process | • Not stated |
17. Conceptual framework for sustainability of public health programs | • Useful in explaining sustainability | • Not able to explain all financial sustainability strategies |