Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions
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Date
2022-05-17
Authors
Song, Yuting
MacEachern, Lauren
Doupe, Malcolm B.
Ginsburg, Liane
Chamberlain, Stephanie A.
Cranley, Lisa
Easterbrook, Adam
Hoben, Matthias
Knopp-Sihota, Jennifer
Reid, R. C.
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Abstract
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 (nā=ā11) 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.
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Citation
BMC Health Services Research. 2022 May 17;22(1):666