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BMC Health Serv Res. 2020 Feb 4;20(1):87. doi: 10.1186/s12913-020-4933-0.

Defining sustainability in practice: views from implementing real-world innovations in health care.

Author information

1
Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada. robin.urquhart@cdha.nshealth.ca.
2
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. robin.urquhart@cdha.nshealth.ca.
3
Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. robin.urquhart@cdha.nshealth.ca.
4
Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
5
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
6
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
7
Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.
8
Interior Health, Kelowna, BC, Canada.
9
Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.
10
The Movember Foundation, Melbourne, Australia.
11
Department of Supportive Care, Princess Margaret Cancer Centre, ELLICSR Cancer Rehabilitation and Survivorship, Toronto, Canada.
12
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Abstract

BACKGROUND:

One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability actually means. Several reviews have helped synthesize and clarify how researchers conceptualize and operationalize sustainability. In this study, we sought to identify how individuals who implement and/or sustain evidence-informed innovations in health care define sustainability.

METHODS:

We conducted in-depth, semi-structured interviews with implementation leaders and relevant staff involved in the implementation of evidence-based innovations relevant to cancer survivorship care (nā€‰=ā€‰27). An inductive approach, using constant comparative analysis, was used for analysis of interview transcripts and field notes.

RESULTS:

Participants described sustainability as an ongoing and dynamic process that incorporates three key concepts and four important conditions. The key concepts were: (1) continued capacity to deliver the innovation, (2) continued delivery of the innovation, and (3) continued receipt of benefits. The key conditions related to (2) and (3), and included: (2a) innovations must continue in the absence of the champion or person/team who introduced it and (3a) adaptation is critical to ensuring relevancy and fit, and thus to delivering the intended benefits.

CONCLUSIONS:

Participants provided a nuanced view of sustainability, with both continued delivery and continued benefits only relevant under certain conditions. The findings reveal the interconnected elements of what sustainability means in practice, providing a unique and important perspective to the academic literature.

KEYWORDS:

Innovations; Qualitative research; Sustainability

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