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Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement

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Doyle, Cathal, Howe, Cathy, Woodcock, Thomas, Myron, Rowan, Phekoo, Karen, McNicholas, Chris, Saffer, Jessica, Bell, Derek·2013·Implementation Science

DOI 10.1186/1748-5908-8-127PMC PMC3827618

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Abstract

The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study indicates the SM provides a potentially useful approach to measuring teams' views on the likelihood of sustainability and prompting action. Securing engagement of teams with the SM was challenging and redesign of elements may need to be considered. Capacity building and facilitation appears necessary for teams to effectively deploy the SM.

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Figure 1 Illustration of scoring mechanism.CC BY · PubMed Central

Figure 2 Trends in domain scores for ‘engaged’ teams.CC BY · PubMed Central

Figure 3 Scoring trends for ‘partly engaged’ teams.CC BY · PubMed Central

Figure 4 ‘Diversity of opinion’ analysis. At each point in time, the distribution shows the frequency of occurrence of each diversity score from 0 (full agreement) to 3 (maximum diversity of opinion). Distributions that are positively skewed (higher frequencies in low scores) indicate less diversity of opinion than negatively skewed distributions (higher frequencies in high scores).CC BY · PubMed Central

Figure 5 Feedback from team members on SM.CC BY · PubMed Central

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Authors: Doyle, C., Howe, C., Woodcock, T., Myron, R., Phekoo, K., McNicholas, C., Saffer, J., & Bell, D.
Affiliations: Chelsea and Westminster Hospital (GB)
Corresponding author: Doyle, Cathal
ORCID: Woodcock, Thomas
Myron, Rowan
Phekoo, Karen
Saffer, Jessica
Bell, Derek
Venue: Implementation Science
Publisher: Springer Science and Business Media LLC
Published: 2013-10-26
Volume: 8
Issue: 1
Pages: 127-127
ISSN: 1748-5908 (ISSN-L)
DOI: 10.1186/1748-5908-8-127
PMC: PMC3827618
OpenAlex: W2156517163
Cited by: 166
References: 15
Citations by year: 2026: 8 · 2025: 8 · 2024: 20 · 2023: 17 · 2022: 15 · 2021: 20 · 2020: 13 · 2019: 17 · 2018: 15 · 2017: 9 · 2016: 9 · 2015: 9 · 2014: 5
FWCI: 13.89
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: Implementation Science (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
UWL Repository (University of West London) (acceptedVersion)
Spiral (Imperial College London) (submittedVersion, cc-by)
Funders: National Institute for Health and Care Research (NIHR-KMF-2012-01-08)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords: evidence-based practice implementation, team engagement, sustainability drivers, formative assessment, opinion diversity, capacity building, healthcare quality improvement
MeSH terms: Diffusion of Innovation, United Kingdom, Hospitals, Public, Patient Care Team, Quality Assurance, Health Care, State Medicine, Program Evaluation, Models, Organizational, Evidence-Based Medicine, Quality Improvement

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Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement

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