Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions
Abstract Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care hom...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08026-x |
| _version_ | 1811341314886729728 |
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| author | Yuting Song Lauren MacEachern Malcolm B. Doupe Liane Ginsburg Stephanie A. Chamberlain Lisa Cranley Adam Easterbrook Matthias Hoben Jennifer Knopp-Sihota R. Colin Reid Adrian Wagg Carole A. Estabrooks Janice M. Keefe Tim Rappon Whitney B. Berta |
| author_facet | Yuting Song Lauren MacEachern Malcolm B. Doupe Liane Ginsburg Stephanie A. Chamberlain Lisa Cranley Adam Easterbrook Matthias Hoben Jennifer Knopp-Sihota R. Colin Reid Adrian Wagg Carole A. Estabrooks Janice M. Keefe Tim Rappon Whitney B. Berta |
| author_sort | Yuting Song |
| collection | DOAJ |
| description | Abstract Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation. Methods Data were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis. Results Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system. Conclusions Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction. |
| first_indexed | 2024-04-13T18:55:02Z |
| format | Article |
| id | doaj.art-f2229260643648a9a78ffcca8da3f0e9 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-13T18:55:02Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-f2229260643648a9a78ffcca8da3f0e92022-12-22T02:34:18ZengBMCBMC Health Services Research1472-69632022-05-0122111410.1186/s12913-022-08026-xInfluences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventionsYuting Song0Lauren MacEachern1Malcolm B. Doupe2Liane Ginsburg3Stephanie A. Chamberlain4Lisa Cranley5Adam Easterbrook6Matthias Hoben7Jennifer Knopp-Sihota8R. Colin Reid9Adrian Wagg10Carole A. Estabrooks11Janice M. Keefe12Tim Rappon13Whitney B. Berta14School of Nursing, Qingdao UniversityManagement & Evaluation, Institute for Health Policy, University of TorontoMax Rady College of Medicine, University of ManitobaSchool of Health Policy & Management, York UniversityDepartment of Family Medicine, University of AlbertaLawrence S. Bloomberg Faculty of Nursing, University of TorontoCentre for Health Evaluation and Outcome Sciences, St. Paul’s HospitalFaculty of Nursing, University of Alberta, Edmonton Clinic Health AcademyFaculty of Health Disciplines, Athabasca UniversitySchool of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia – Okanagan campusDepartment of Medicine, University of AlbertaFaculty of Nursing, University of Alberta, Edmonton Clinic Health AcademyNova Scotia Centre On Aging, Mount Saint Vincent UniversityManagement & Evaluation, Institute for Health Policy, University of TorontoManagement & Evaluation, Institute for Health Policy, University of TorontoAbstract Background Complex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation. Methods Data were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis. Results Sustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system. Conclusions Our findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction.https://doi.org/10.1186/s12913-022-08026-xImplementation ScienceCaregiving – FormalManagementLong-term Care |
| spellingShingle | Yuting Song Lauren MacEachern Malcolm B. Doupe Liane Ginsburg Stephanie A. Chamberlain Lisa Cranley Adam Easterbrook Matthias Hoben Jennifer Knopp-Sihota R. Colin Reid Adrian Wagg Carole A. Estabrooks Janice M. Keefe Tim Rappon Whitney B. Berta Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions BMC Health Services Research Implementation Science Caregiving – Formal Management Long-term Care |
| title | Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions |
| title_full | Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions |
| title_fullStr | Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions |
| title_full_unstemmed | Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions |
| title_short | Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions |
| title_sort | influences of post implementation factors on the sustainability sustainment and intra organizational spread of complex interventions |
| topic | Implementation Science Caregiving – Formal Management Long-term Care |
| url | https://doi.org/10.1186/s12913-022-08026-x |
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