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Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions Song, Yuting; MacEachern, Lauren; Doupe, Malcolm B.; Ginsburg, Liane; Chamberlain, Stephanie A.; Cranley, Lisa; Easterbrook, Adam; Hoben, Matthias; Knopp-Sihota, Jennifer; Reid, R. Colin; Wagg, Adrian; Estabrooks, Carole A.; Keefe, Janice M.; Rappon, Tim; Berta, Whitney B.

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.

Item Metadata

Title
Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions
Creator
Song, Yuting; MacEachern, Lauren; Doupe, Malcolm B.; Ginsburg, Liane; Chamberlain, Stephanie A.; Cranley, Lisa; Easterbrook, Adam; Hoben, Matthias; Knopp-Sihota, Jennifer; Reid, R. Colin; Wagg, Adrian; Estabrooks, Carole A.; Keefe, Janice M.; Rappon, Tim; Berta, Whitney B.
Contributor
Centre for Health Evaluation & Outcome Sciences
Publisher
BioMed Central
Date Issued
2022-05-17
Description
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.
Subject
Implementation Science; Caregiving – Formal; Management; Long-term Care
Genre
Article
Type
Text
Language
eng
Date Available
2022-08-12
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0417288
URI
http://hdl.handle.net/2429/82352
Affiliation
Health and Social Development, Faculty of (Okanagan); Non UBC; Health and Exercise Sciences, School of (Okanagan)
Citation
BMC Health Services Research. 2022 May 17;22(1):666
Publisher DOI
10.1186/s12913-022-08026-x
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher; Other
Copyright Holder
The Author(s)
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Attribution 4.0 International (CC BY 4.0)