The Sustain and Spread Framework: strategies for sustaining and spreading nutrition care improvements in acute care based on thematic analysis from the More-2-Eat study
Open accessAbstract
BACKGROUND: Successful improvements in health care practice need to be sustained and spread to have maximum benefit. The rationale for embedding sustainability from the beginning of implementation is well recognized; however, strategies to sustain and spread successful initiatives are less clearly described. The aim of this study is to identify strategies used by hospital staff and management to sustain and spread successful nutrition care improvements in Canadian hospitals. METHODS: The More-2-Eat project used participatory action research to improve nutrition care practices. Five hospital units in four Canadian provinces had one year to improve the detection, treatment, and monitoring of malnourished patients. Each hospital had a champion and interdisciplinary site implementation team to drive changes. After the year (2016) of implementing new practices, site visits were completed at each hospital to conduct key informant interviews (n = 45), small group discussions (4 groups; n = 10), and focus groups (FG) (11 FG; n = 71) (total n = 126) with staff and management to identify enablers and barriers to implementing and sustaining the initiative. A year after project completion (early 2018) another round of interviews (n = 12) were conducted to further understand sustaining and spreading the initiative to other units or hospitals. Verbatim transcription was completed for interviews. Thematic analysis of interview transcripts, FG notes, and context memos was completed. RESULTS: After implementation, sites described a culture change with respect to nutrition care, where new activities were viewed as the expected norm and best practice. Strategies to sustain changes included: maintaining the new routine; building intrinsic motivation; continuing to collect and report data; and engaging new staff and management. Strategies to spread included: being responsive to opportunities; considering local context and readiness; and making it easy to spread. Strategies that supported both sustaining and spreading included: being and staying visible; and maintaining roles and supporting new champions. CONCLUSIONS: The More-2-Eat project led to a culture of nutrition care that encouraged lasting positive impact on patient care. Strategies to spread and sustain these improvements are summarized in the Sustain and Spread Framework, which has potential for use in other settings and implementation initiatives. TRIAL REGISTRATION: Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304 , June 7, 2016.
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At the team level, a committed team champion to galvanize interest and take on a leadership role was critical to both sustaining and scaling.
“At the team level, a committed team champion to galvanize interest and take on a leadership role was critical to both sustaining and scaling, a finding reported by others [26, 41, 42].”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [41]
A key intervention-based factor was access to well-developed clinic processes and tools.
“A key intervention-based factor was access to well-developed clinic processes and tools, which aligns with earlier recommendations of making the innovation easy to scale [41] and having a model provided [42].”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [41]
Scale-up is facilitated by considering local context and readiness, and by being responsive to opportunities.
“The Spread and Sustain framework [41] is based on a study that found scale-up was facilitated by considering local context and readiness, and being responsive to opportunities.”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [41]
Even after innovations become part of routine practice, effort is still required for maintaining the routine.
“Laur et al., who developed the Sustain and Spread Framework [41], found that even after innovations were becoming part of routine practice, effort was still required for “maintaining the routine” [p. 4].”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [41]
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Cites
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009) · Implementation Science · doi:10.1186/1748-5908-4-50 · Cited by 14,496 · see citing works
Michie, S., van Stralen, M. M., & West, R. (2011) · Implementation Science · doi:10.1186/1748-5908-6-42 · Cited by 13,697 · see citing works
Cane, J., O’Connor, D., & Michie, S. (2012) · Implementation Science · doi:10.1186/1748-5908-7-37 · Cited by 4,888 · cited 2× · see citing works
“The Knowledge-to-Action framework [12], the Theoretical Domains Framework [19], the Consolidated Framework for Implementation Research [20], the Model for Improvement [21], and the Normalization Process Theory [22, 23], were used to support implementation of INPAC [15].”
BackgroundMethodLost in knowledge translation: Time for a map?
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.47 · Cited by 4,705 · see citing works
Holstein, J. A., & Gubrium, J. F. (1995) · Sage eBooks · doi:10.4135/9781412986120 · Cited by 3,074 · see citing works
Baum, F., MacDougall, C., & Smith, D. (2006) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2004.028662 · Cited by 2,420 · see citing works
The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change
Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013) · Implementation Science · doi:10.1186/1748-5908-8-117 · Cited by 1,724 · see citing works
Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., Finch, T., Kennedy, A., Mair, F., O'Donnell, C., et al. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-63 · Cited by 1,478 · see citing works
Development of a theory of implementation and integration: Normalization Process Theory
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., et al. (2009) · Implementation Science · doi:10.1186/1748-5908-4-29 · Cited by 1,409 · cited 2× · see citing works
“The Knowledge-to-Action framework [12], the Theoretical Domains Framework [19], the Consolidated Framework for Implementation Research [20], the Model for Improvement [21], and the Normalization Process Theory [22, 23], were used to support implementation of INPAC [15].”
MethodHospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System
Barker, L. A., Gout, B. S., & Crowe, T. C. (2011) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph8020514 · Cited by 985 · see citing works
The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care
Shelton, R. C., Cooper, B. R., & Stirman, S. W. (2018) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-040617-014731 · Cited by 806 · see citing works
Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices
Prasad, V., & Ioannidis, J. P. (2014) · Implementation Science · doi:10.1186/1748-5908-9-1 · Cited by 723 · see citing works
Kilbourne, A. M., Neumann, M. S., Pincus, H. A., Bauer, M. S., & Stall, R. (2007) · Implementation Science · doi:10.1186/1748-5908-2-42 · Cited by 653 · see citing works
Developing a comprehensive definition of sustainability
Moore, J. E., Mascarenhas, A., Bain, J., & Straus, S. E. (2017) · Implementation Science · doi:10.1186/s13012-017-0637-1 · Cited by 630 · see citing works
Aarons, G. A., Ehrhart, M. G., & Farahnak, L. R. (2014) · Implementation Science · doi:10.1186/1748-5908-9-45 · Cited by 559 · see citing works
Agarwal, E., Ferguson, M. L., Banks, M., Batterham, M. J., Bauer, J. D., Capra, S. M., & Isenring, E. A. (2012) · Clinical Nutrition · doi:10.1016/j.clnu.2012.11.021 · Cited by 472 · see citing works
Lennox, L., Maher, L., & Reed, J. (2018) · Implementation Science · doi:10.1186/s13012-017-0707-4 · Cited by 421 · see citing works
Implementing culture change in health care: theory and practice
SCOTT, T. (2003) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzg021 · Cited by 419 · see citing works
“Scaling-out” evidence-based interventions to new populations or new health care delivery systems
Aarons, G. A., Sklar, M., Mustanski, B., Benbow, N., & Brown, C. H. (2017) · Implementation Science · doi:10.1186/s13012-017-0640-6 · Cited by 399 · see citing works
Towards understanding the de-adoption of low-value clinical practices: a scoping review
Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015) · BMC Medicine · doi:10.1186/s12916-015-0488-z · Cited by 369 · see citing works
Quality improvement research: understanding the science of change in health care
Grol, R. P. T. M. (2002) · BMJ Quality & Safety · doi:10.1136/qhc.11.2.110 · Cited by 296 · see citing works
Allard, J., Keller, H., Jeejeebhoy, K., Laporte, M., Duerksen, D., Gramlich, L., Payette, H., Bernier, P., Vesnaver, E., Davidson, B., et al. (2016) · JPEN - Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607114567902 · Cited by 255 · see citing works
Self-citationParmelli, E., Flodgren, G., Beyer, F. R., Baillie, N., Schaafsma, M. E., & Eccles, M. (2011) · Implementation Science · doi:10.1186/1748-5908-6-33 · Cited by 217 · see citing works
Ernstzen, D. V., Louw, Q. A., & Hillier, S. (2017) · Implementation Science · doi:10.1186/s13012-016-0533-0 · Cited by 189 · see citing works
Role of Champions in the Implementation of Patient Safety Practice Change
Soo, S., Berta, W. B., & Baker, G. R. (2009) · Healthcare Quarterly · doi:10.12927/hcq.2009.20979 · Cited by 162 · see citing works
Effective strategies for scaling up evidence-based practices in primary care: a systematic review
Charif, A. B., Zomahoun, H. T. V., LeBlanc, A., Langlois, L., Wolfenden, L., Yoong, S. L., Williams, C. M., Lépine, R., & Légaré, F. (2017) · Implementation Science · doi:10.1186/s13012-017-0672-y · Cited by 140 · see citing works
The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
Keller, H., McCullough, J., Davidson, B., Vesnaver, E., Laporte, M., Gramlich, L. M., Allard, J. P., Bernier, P., Duerksen, D. R., & Jeejeebhoy, K. N. (2015) · Nutrition Journal · doi:10.1186/s12937-015-0051-y · Cited by 101 · see citing works
Self-citationBush, P. L., Pluye, P., Loignon, C., Granikov, V., Wright, M. T., Pelletier, J., Bartlett‐Esquilant, G., Macaulay, A. C., Haggerty, J. L., Parry, S., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0648-y · Cited by 95 · see citing works
Will prescriptions for cultural change improve the NHS?
Davies, H. T. O., & Mannion, R. (2013) · BMJ · doi:10.1136/bmj.f1305 · Cited by 83 · see citing works
Changing nutrition care practices in hospital: a thematic analysis of hospital staff perspectives
Laur, C. V., Valaitis, R. F., Bell, J., & Keller, H. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2409-7 · Cited by 62 · see citing works
Self-citationThe effectiveness of strategies to change organisational culture to improve healthcare performance
Parmelli, E., Flodgren, G., Schaafsma, M. E., Baillie, N., Beyer, F. R., & Eccles, M. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008315.pub2 · Cited by 51 · see citing works
Ilott, I., Gerrish, K., Pownall, S., Eltringham, S., & Booth, A. (2013) · Implementation Science · doi:10.1186/1748-5908-8-128 · Cited by 50 · see citing works
Keller, H., Laur, C. V., Atkins, M., Bernier, P., Butterworth, D., Davidson, B., Hotson, B., Nasser, R., Laporte, M., Marcell, C., et al. (2018) · Nutrition Journal · doi:10.1186/s12937-017-0310-1 · Cited by 46 · see citing works
Self-citationKeller, H., Valaitis, R. F., Laur, C. V., McNicholl, T., Xu, Y., Dubin, J. A., Curtis, L., Obiorah, S., Ray, S., Bernier, P., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.02.009 · Cited by 41 · see citing works
Self-citationPredictors of dietitian consult on medical and surgical wards
Keller, H., Allard, J. P., Laporte, M., Davidson, B., Payette, H., Bernier, P., Jeejeebhoy, K. N., Duerksen, D. R., & Gramlich, L. M. (2014) · Clinical Nutrition · doi:10.1016/j.clnu.2014.11.011 · Cited by 37 · see citing works
Self-citationfor the More-2-Eat team, Keller, H., Laur, C. V., Valaitis, R. F., Bell, J., McNicholl, T., Ray, S., Murphy, J., & Barnes, S. (2017) · BMC Nutrition · doi:10.1186/s40795-017-0127-5 · Cited by 31 · see citing works
Self-citationFrom pilot project to system solution: innovation, spread and scale for health system leaders
Shaw, J., Tepper, J. D., & Martin, D. (2018) · BMJ Leader · doi:10.1136/leader-2017-000055 · Cited by 30 · see citing works
Low food intake in hospital: patient, institutional, and clinical factors.
Curtis, L. J., Valaitis, R., Laur, C., McNicholl, T., Nasser, R., & Keller, H. (2018) · Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme · doi:10.1139/apnm-2018-0064 · Cited by 28 · see citing works
Self-citationValaitis, R. F., Laur, C. V., Keller, H., Butterworth, D., & Hotson, B. (2017) · BMC Nutrition · doi:10.1186/s40795-017-0177-8 · Cited by 25 · see citing works
Self-citationStructural analysis of health-relevant policy-making information exchange networks in Canada
Contandriopoulos, D., Benoît, F., Bryant‐Lukosius, D., Carrier, A., Carter, N., Deber, R. B., Duhoux, A., Greenhalgh, T., Larouche, C., Leclerc, B., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0642-4 · Cited by 25 · see citing works
Laur, C. V., Keller, H., Curtis, L., Douglas, P., Murphy, J., & Ray, S. (2017) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607117718493 · Cited by 18 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 3
- [1]Straus S Tetroe J Graham ID Knowledge translation in health care. Moving from evidence to practice. Selecting, tailoring, and implementing knowledge translation interventions. 2nd editio 2013 Oxford Wiley-Blackwell BMJ Books
- [17]Valaitis R, Laur C, Keller H, Butterworth D, Hotson B. Need for the integrated nutrition pathway for acute care (INPAC): gaps in current nutrition care in five Canadian hospitals. BMC Nutr. 2017;3:60. PMC7050887 32153840
- [30]McNicholl T, Valaitis R, Laur C, Keller H. The More-2-eat project: using theory to explain behaviour change techniques in a hospital setting. Appl Physiol Nutr Metab. 2017;42:S33.
Cited by
Sorted by citations
Daly, R. M., Iuliano, S., Fyfe, J. J., Scott, D. S., Kirk, B., Thompson, M. Q., Dent, E., Fetterplace, K., Wright, O. R. L., Lynch, G. S., et al. (2022) · The journal of nutrition health & aging · doi:10.1007/s12603-022-1801-0 · Cited by 102 · see citing works
A conceptual model to guide research on the activities and effects of innovation champions
Shea, C. M. (2021) · Implementation Research and Practice · doi:10.1177/2633489521990443 · Cited by 92 · see citing works
Moon, S., Hogden, A., & Eljiz, K. (2022) · BMJ Open Quality · doi:10.1136/bmjoq-2022-002057 · Cited by 68 · see citing works
Wen, J., Gabryś, B., & Musiał, K. (2022) · IEEE Access · doi:10.1109/access.2022.3184801 · Cited by 46 · see citing works
Keller, H., Valaitis, R. F., Laur, C. V., McNicholl, T., Xu, Y., Dubin, J. A., Curtis, L., Obiorah, S., Ray, S., Bernier, P., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.02.009 · Cited by 41 · see citing works
Self-citationBell, J., Young, A., Hill, J. M., Banks, M., Comans, T. A., Barnes, R., & Keller, H. (2021) · Nutrition & Dietetics · doi:10.1111/1747-0080.12663 · Cited by 36 · see citing works
Self-citationKeller, H., Koechl, J. M., Laur, C. V., Chen, H., Curtis, L., Dubin, J. A., Gramlich, L. M., Ray, S., Valaitis, R. F., Yang, Y., et al. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.09.034 · Cited by 31 · see citing works
Self-citationMorgan, D., Kosteniuk, J., O’Connell, M. E., Seitz, D., Elliot, V., Bayly, M., Chow, A. F., & Cameron, C. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07550-0 · Cited by 20 · see citing works
Wieland, M. L., Asiedu, G. B., Njeru, J. W., Weis, J. A., Lantz, K., Abbenyi, A., Molina, L. E., Ahmed, Y. A., Osman, A., Goodson, M., et al. (2022) · Public Health Reports · doi:10.1177/00333549211065514 · Cited by 20 · see citing works
Rushton, A., Edwards, A., Bauer, J. D., & Bell, J. (2021) · Nutrition & Dietetics · doi:10.1111/1747-0080.12651 · Cited by 21 · see citing works
Self-citationBell, J., Geirsdóttir, Ó. G., Hertz, K., Santy‐Tomlinson, J., Skúladóttir, S. S., Eleuteri, S., & Johansen, A. (2020) · Practical issues in geriatrics · doi:10.1007/978-3-030-48126-1_18 · Cited by 17 · see citing works
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Laur, C. V., Bell, J., Valaitis, R. F., Ray, S., & Keller, H. (2021) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2021-000281 · Cited by 14 · see citing works
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Rushton, A., Young, A., Keller, H., Bauer, J. D., & Bell, J. (2021) · Healthcare · doi:10.3390/healthcare9040446 · Cited by 9 · see citing works
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Self-citationRushton, A., Elmas, K., Bauer, J. D., & Bell, J. (2021) · Nutrients · doi:10.3390/nu13062063 · Cited by 10 · see citing works
Self-citationMaier, A. B., Chew, S. T. H., Goh, J., Koh, F. H.-X., & Tan, N. C. (2023) · The Journal of Frailty & Aging · doi:10.14283/jfa.2023.31 · Cited by 7 · see citing works
Laur, C. V., Butterworth, D., Nasser, R., Bell, J., Marcell, C., Murphy, J., Valaitis, R. F., Bernier, P., Ray, S., & Keller, H. (2018) · Nutrition in Clinical Practice · doi:10.1002/ncp.10207 · Cited by 6 · see citing works
Self-citationMolle, J., Agnel, J., Colson, S., & Chays‐Amania, A. (2025) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2025.100414 · Cited by 7 · see citing works
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Self-citationWilkinson, S. A., Bell, J., Neaves, B., McCray, S. J., & Campbell, K. L. (2022) · International Journal of Evidence-Based Healthcare · doi:10.1097/xeb.0000000000000333 · Cited by 3 · see citing works
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Self-citationXu, Y. Y., Warren, R. A., Peters, S. M., Boudreau, S., Strickland, T. N., Somerville, M., MacDonald, B. L., Keller, H., & Cahill, L. E. (2025) · Clinical Nutrition Open Science · doi:10.1016/j.nutos.2025.01.007
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Self-citationde Klerk, E. S., Preckel, B., van den Boomen, L. W., Soeters, M. R., Visser, A., van Etten‐Jamaludin, F. S., Hollmann, M. W., Hermanides, J., & van Stijn, M. F. M. (2025) · Clinical Nutrition · doi:10.1016/j.clnu.2025.106548
- Authors
- Laur, C., Bell, J., Valaitis, R., Ray, S., & Keller, H.
- Affiliations
- University of Waterloo (CA)
- The University of Queensland (AU)
- Corresponding author
- Keller, Heather
- Venue
- BMC Health Services Research
- Published
- 2018-12
- Volume
- 18
- Issue
- 1
- Pages
- 930-930
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC6278089
- OpenAlex
- W2903101238
- Cited by
- 30
- References
- 41
- Citations by year
- 2025: 7 · 2024: 1 · 2023: 3 · 2022: 6 · 2021: 8 · 2020: 2 · 2019: 1 · 2018: 2
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo
- Funders
- Canadian Frailty Network (SIG2014-08)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- nutrition care, implementation sustainability, acute care, organizational culture change, champions, intrinsic motivation, implementation barriers and facilitators
- MeSH terms
- Acute Disease, Adult, Aged, Canada, Critical Care, Delivery of Health Care, Female, Health Facility Size, Hospital Units, Hospitalization, Humans, Longitudinal Studies, Male, Middle Aged, Personnel, Hospital, Retrospective Studies, Focus Groups, Nutritional Support, Qualitative Research, Quality Improvement
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