Table 3 Sustainability approaches demonstrating use in practice

1. Normalisation Process Theory [113]

To explore the social organisation of the work (implementation), of making practices routine elements of everyday life (embedding) and of sustaining embedded practices in their social contexts (integration)

Coherence (or sense-making), cognitive participation (or engagement), collective action (work done to enable the intervention to happen), and reflexive monitoring (formal and informal appraisal of the benefits and costs of the intervention)

2. Normalisation Process Model [114]

To assist in explaining the processes by which complex interventions become routinely embedded in healthcare practice

Interactional workability, relational integration, skill-set workability, contextual integration

3. Level of Institutionalisation Scale [115]

To measure the extent of programme integration into an organisation

Production routine, production niche saturation, maintenance routine, maintenance niche saturation, supportive routine, supportive niche saturation, managerial routine, managerial niche saturation

4. Program Sustainability Assessment Tool [116]

To assess and plan for sustainability risks and develop an action plan

Political support, funding stability, partnerships, organisational capacity, programme evaluation, programme adaptation, communications, strategic planning

5. Program Sustainability Index [23]

To evaluate community-based programme sustainability

Leadership competence, effective collaboration, understanding the community, demonstrating programme results, strategic funding, staff involvement, integration, programme responsivity

6. NHS III Sustainability Model [20]

To predict the likelihood of sustainability and guide teams to things they could do to increase the chances that the change for improvement will be sustained

Staff involvement and training, staff attitudes towards sustaining the change, senior leadership engagement, clinical leadership, fit with the organisation’s strategic aims and culture, infrastructure for sustainability, benefits beyond helping patient, credibility of the benefits, adaptability of improved process, effectiveness of the system to monitor progress

7. Slaghuis’s Framework and Instrument for Sustainability [117]

To analyse sustainability of actual changed work practices and evaluate improvement projects

Routinisation I (principle forming practice), Routinisation II (variations in practice), routinisation III (feedback on performance), institutionalisation of skills, institutionalisation of documentation materials, institutionalisation of practical materials, institutionalisation of team reflection

8. The ARCC (Advancing Research and Clinical practice through close Collaboration) Model [118]

To provide healthcare systems with a conceptual framework to guide system-wide implementation and sustainability of evidence-based practice (EBP) for the purpose of improving quality of care and patient outcomes

Culture, organisational readiness, Philosophy of EBP Presence of EBP mentors and champions, administrative support, EBP knowledge and skills, EBP value, ability to implement the EBP process

9. Conceptual Framework for Planning for Sustainability of Community-based Health Programs [1]

To conceptualise and measure sustainability with tentative guidelines to facilitate sustainability in community programmes

Project negotiation process, project effectiveness, project duration, project financing, project type, training, institutional strength, integration with existing programs/services, programme champion/leadership, socioeconomic and political considerations, community participation

10. Leffer’s Conceptual Framework for Partnership and Sustainability [119]

To offer guidance and a framework for partnership and sustainability for nurses who participate in global efforts

Design and implementation, community assessment, organisational setting, resources, broader host community, social and political climate, community participation, Processes: leadership champion, Outcomes, project ownership

11. Atun’s Conceptual Framework for Analysing Integration of Targeted Health Interventions into Health Systems [120]

To analyse and map the nature and extent of integration in different settings, along with the factors that influence the integration process

Nature of the problem, the intervention, the adoption system, health system characteristics, context

12. Shell’s Capacity for Sustainability Framework [121]

To provide a framework on sustainability capacity, identifying organisational and contextual characteristics necessary for successfully sustaining programmes over time

Political support, funding stability, partnerships, organisational capacity, programme evaluation, programme adaptation, communications, public health impacts and strategic planning

13. Fox’s Sustainability of Innovation Theoretical Framework [122]

To guide research, determine variables, influence data analysis

Political factors (policy alignment, link with visions and goals, champion involvement, staff involvement), organisational (communications, adaptation of the innovation, networking opportunities), financial (funding sources, budgetary planning, evaluation strategies), workforce (staff recruitment, education and training, perception of need for innovation, perception of quality and safety), innovation (support for innovation, barriers, quality and safety)

14. Conceptual Framework for Sustainability of Public Health Programs [17]

To guide the sustainability research agenda and enable accumulation of findings about sustainability.

intervention with evidence for effectiveness, organisational capacity, prior relationships and partnerships, intervention characteristics, organisational support, environmental support, financial resources

15. Gruen’s Model of Health-Programme Sustainability [22]

To provide a model of health-programme sustainability based on context and resource availability

Health concerns, programme elements, drivers of the programme, context, resource availability

16. The Sustainability Analysis Process [123]

To conceptualise and measure the sustainability of health systems in low-income countries and fragile states

Sustainability indicators and characterisation are developed by users and based on the the local context and setting

17. Fleiszer’s Framework for the Sustainability of Healthcare Innovations [124]

To guide data collection and content analysis

Culture, interprofessional collaboration, financial resources, external pressure, extra-organisational partnerships, relevance of the programme, nature of the programme, reflection strategy, co-directorship of the programme, commitment of leaders, complementarity of leadership actions

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