More about the phase 'Sustain Knowledge Use'

More about sustain knowledge use

Five important characteristics that help sustain a practice change 

Here are five characteristics that you and your change team may wish to consider for your practice change. Ensuring that all these characteristics are part of your implementation plan can maximize the chances that your practice change will be sustained in your setting.

  1. A program can be modified over time.
  2. Champions are present.
  3. A program “fits” with its organization’s mission and procedures.
  4. Benefits to staff members and/or clients are readily perceived. 
  5. Stakeholders in other organizations provide support.

SOURCE: Lennox et al., 2018. 

Factors to consider when planning for sustainability

Top three factors that help sustainability:

  • alignment of the innovation with the organization’s priorities and values;
  • sufficient funding to support the ongoing practice/intervention; and 
  • leaders, formal and informal who support the practice/intervention.

Top three factors that hinder sustainability:

  • limited or lack of funding;
  • lack of resources; and 
  • absence of leadership.

Factors that influence sustainability can be classified into four domains

Researchers broadly classify factors that influence sustainability in four domains (Hailemariam et al.,2019):

  • Innovation: New process, change, product, practice, program, innovation, or intervention.
  • Context: Inner setting: Context, practice setting or organization; Outer setting: External condition, context, system, or environment.
  • Processes: Processes, methods, systems, structures, or strategies.
  • Capacity: Characteristics of an organization to sustain the implementation gains, characterized by workforce characteristics.

The table below outlines a host of other factors that help or hinder sustainability, sorted by different domains. (Hailemariam et al., 2019). 

  Innovation Context (Inner or Outer Setting) Processes Capacity
Helping factors
  • Innovation fit.
  • Evidence-based practice (EBP) effectiveness or benefit.
  • Ability to modify the practice change.
  • Ability to maintain EBP fidelity/integrity.
  • Setting characteristics (structures, policies).
  • System/ policy change.
  • Engagement/ relationship building.
  • Organizational culture.
  • Training and education.
  • Ongoing support.
  • Collaboration/ partnership.
  • Integration of rules and policies.   
  • Evaluation and feedback.
  • Engagement/ relationship building.    
  • Shared decision-making among stakeholders.
  • Planning.
  • Existing or added capacity to sustain (e.g., workforce characteristics and stability, interpersonal processes).
Hindering factors
  • Practice change effectiveness or benefit was not observed.        
  • No ability to modify the practice change.
  • Practice change did not fit with the organization or its workflow.
  • Organizational leadership did not support the sustainability of the practice change.
  • Setting characteristics (structures, policies) did not support the practice change. 
  • The organizational climate did not support the sustained practice change.
  • System/policy change that no longer aligns with the practice change. 
  • Training and education are not sustained.
  • No ongoing support.
  • No sustained planning.
  • Poor collaboration/ partnership.
  • Internal/external practice change champions did not support the sustainment of practice change
  • Lack of trained personnel to continue the practice change
  • Community stakeholders did not support the sustainment of practice change

Remember: At times, discontinuation of a particular intervention may be the result of development or discovery of more effective, efficient, or compatible practices adaptations, a partial continuation of a program or intervention, or integration of new practices may occur in response to new evidence, changes in priorities or resource availability, or other contextual influence. (Stirman et al., 2012)