Change teams, health-care providers, researchers and other stakeholders typically consider the two dimensions of sustainability.
Sustainability as a dynamic process
Sustainability as an outcome
Sustainability is largely considered as a process – it is a phase of ongoing knowledge use after implementation efforts come to an end (Lennox et al., 2018).
Sustainability is not an ‘all-or-nothing’ phase or an endgame, but rather a process of managing and supporting the intervention that has been implemented, or a new practice that has been introduced into the clinical setting (Urquhart et al., 2020).
The nature of the sustainability phase is dynamic, because planning for and measuring the extent to which an intervention or practice is sustained, can be a series of complex activities that require careful planning (Penno et al., 2019).
Sustainability can also be considered an outcome –where health benefits, clinical practices, and intervention activities are maintained (Lennox et al., 2018).
Sustainability outcomes are “the subsequent impact (health-care improvement or public health outcomes) of sustained intervention use” (Proctor et al., 2015).
The sustainability of a new intervention or practice directly leads to measurable outcomes at the individual, organizational or systems level.
It is not uncommon for change teams to use these different levels of outcomes as both direct and indirect measures of whether sustainment is achieved for a change (Lennox et al., 2018).
