Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions
Abstract Background Quality improvement (QI) evaluations rarely consider how a successful intervention can be sustained long term, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | Implementation Science Communications |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43058-021-00137-6 |
| _version_ | 1818381075442827264 |
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| author | Celia Laur Ann Marie Corrado Jeremy M. Grimshaw Noah Ivers |
| author_facet | Celia Laur Ann Marie Corrado Jeremy M. Grimshaw Noah Ivers |
| author_sort | Celia Laur |
| collection | DOAJ |
| description | Abstract Background Quality improvement (QI) evaluations rarely consider how a successful intervention can be sustained long term, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained. This study explores why and how the effective interventions were sustained, spread, or scaled. Methods A qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for telephone interviews. Authors were eligible if they had completed the author survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed “effective.” Snowball sampling was used if the participant identified someone who could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify barriers and facilitators to sustainability, spread, and/or scale of the QI program, using case examples to show trajectories across projects and people. Results Eleven of 44 eligible trialists participated in an interview. Four reported that the intervention was “sustained” and nine were “spread,” however, interviews highlighted that these terms were interpreted differently over time and between participants. Participant stories highlighted the varied trajectories of how projects evolved and how some research careers adapted to increase impact. Three interacting themes, termed the “3C’s,” helped explain the variation in sustainability, spread, and scale: (i) understanding the concepts of implementation, sustainability, sustainment, spread, and scale; (ii) having the appropriate competencies; and (iii) the need for individual, organizational, and system capacity. Conclusions Challenges in defining sustainability, spread and scale make it difficult to fully understand impact. However, it is clear that from the beginning of intervention design, trialists need to understand the concepts and have the competency and capacity to plan for feasible and sustainable interventions that have potential to be sustained, spread and/or scaled if found to be effective. |
| first_indexed | 2024-12-14T02:28:49Z |
| format | Article |
| id | doaj.art-2b29d166b9e14a0287bc1838a2fc2f1e |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-14T02:28:49Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-2b29d166b9e14a0287bc1838a2fc2f1e2022-12-21T23:20:19ZengBMCImplementation Science Communications2662-22112021-04-012111310.1186/s43058-021-00137-6Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventionsCelia Laur0Ann Marie Corrado1Jeremy M. Grimshaw2Noah Ivers3Women’s College Hospital Institute for Health System Solutions and Virtual Care, and Women’s College Research Institute, Women’s College HospitalThe Peter Gilgan Centre for Women’s Cancers, Women’s College HospitalClinical Epidemiology Program, Ottawa Hospital Research InstituteWomen’s College Hospital Institute for Health System Solutions and Virtual Care, and Women’s College Research Institute, Women’s College HospitalAbstract Background Quality improvement (QI) evaluations rarely consider how a successful intervention can be sustained long term, nor how to spread or scale to other locations. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained. This study explores why and how the effective interventions were sustained, spread, or scaled. Methods A qualitative approach was used, focusing on case examples. Diabetes QI program trial authors were purposefully sampled and recruited for telephone interviews. Authors were eligible if they had completed the author survey, agreed to follow-up, and had a completed a diabetes QI trial they deemed “effective.” Snowball sampling was used if the participant identified someone who could provide a different perspective on the same trial. Interviews were transcribed verbatim. Inductive thematic analysis was conducted to identify barriers and facilitators to sustainability, spread, and/or scale of the QI program, using case examples to show trajectories across projects and people. Results Eleven of 44 eligible trialists participated in an interview. Four reported that the intervention was “sustained” and nine were “spread,” however, interviews highlighted that these terms were interpreted differently over time and between participants. Participant stories highlighted the varied trajectories of how projects evolved and how some research careers adapted to increase impact. Three interacting themes, termed the “3C’s,” helped explain the variation in sustainability, spread, and scale: (i) understanding the concepts of implementation, sustainability, sustainment, spread, and scale; (ii) having the appropriate competencies; and (iii) the need for individual, organizational, and system capacity. Conclusions Challenges in defining sustainability, spread and scale make it difficult to fully understand impact. However, it is clear that from the beginning of intervention design, trialists need to understand the concepts and have the competency and capacity to plan for feasible and sustainable interventions that have potential to be sustained, spread and/or scaled if found to be effective.https://doi.org/10.1186/s43058-021-00137-6SustainabilitySpreadScaleImplementationLearning health systemsKnowledge translation |
| spellingShingle | Celia Laur Ann Marie Corrado Jeremy M. Grimshaw Noah Ivers Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions Implementation Science Communications Sustainability Spread Scale Implementation Learning health systems Knowledge translation |
| title | Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions |
| title_full | Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions |
| title_fullStr | Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions |
| title_full_unstemmed | Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions |
| title_short | Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions |
| title_sort | trialists perspectives on sustaining spreading and scaling up of quality improvement interventions |
| topic | Sustainability Spread Scale Implementation Learning health systems Knowledge translation |
| url | https://doi.org/10.1186/s43058-021-00137-6 |
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