A framework and a measurement instrument for sustainability of work practices in long-term care
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BACKGROUND: In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization. METHODS: The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual = 112). Data were collected not until at least one year had passed after implementation.Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed. RESULTS: The χ2- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p < .01). Secondly, construct validity of the instrument was strong as indicated by the high factor loadings of the items. Finally, the internal consistency of the subscales was good. CONCLUSIONS: The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.
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Eleven approaches aimed to examine sustainability at an organisational or systems level.
“Eleven approaches aimed to examine sustainability at an organisational or systems level (e.g. a long-term care organisation) [32].”
From Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare (2018) · cites this paper as [32]
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Sustainable care improvement programs supported by undergraduate health care education
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How lean routines shape a continuous improvement dynamic capability in hospitals
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- Authors
- Slaghuis, S. S., Strating, M. M., Bal, R. A., & Nieboer, A. P.
- Affiliations
- Erasmus University Rotterdam (NL)
- Corresponding author
- Slaghuis, Sarah S
- Venue
- BMC Health Services Research
- Published
- 2011-11-16
- Volume
- 11
- Issue
- 1
- Pages
- 314-314
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3234291
- OpenAlex
- W2057818000
- Cited by
- 71
- References
- 38
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 6 · 2021: 1 · 2020: 12 · 2019: 4 · 2018: 7 · 2017: 3 · 2016: 6 · 2015: 5 · 2014: 3 · 2013: 6 · 2012: 2
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- ZonMw
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Appreciative Inquiry and Organizational Change
- Keywords
- long-term care, quality improvement, routinization, institutionalization, scale development, theoretical framework, implementation evaluation, psychometric validation
- MeSH terms
- Adult, Female, Follow-Up Studies, Health Services Research, Humans, Long-Term Care, Male, Middle Aged, Netherlands, Psychometrics, Quality Assurance, Health Care, Quality Improvement
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