Two dimensions of sustainability

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).