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Table 4 Benefits and challenges reported for individual approaches

From: Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review

Sustainability approach Benefits Challenges
1. Normalisation process theory • Aided users to expose the ‘hidden work’ that needs to occur to create health-promoting systems
• Created understanding of the barriers to implementation and identified potential strategies to address barriers
• Provided framework to organise findings
• Facilitated analysis of implementation from multiple perspectives and understanding of experiences of healthcare workers at the individual and organisational level
• Drawing planners’ attention to potential problems to address during implementation
• Further development needed to link constructs to specific behaviour-change techniques
• Overlap and difficulty of discerning the difference between the constructs
• Based on perceptions of individual users; therefore, risk of bias and leaving some contextual factors beyond the scope of knowledge
2. Normalisation process model • Allowed the identification of barriers and facilitators impacting the programme
• Provided framework to organise findings
• Facilitated a deeper and more dynamic analysis
• Difficult to assign to a single category to the data as categories overlap
3. Level of institutionalisation scale • Allowed an aspect of continuous evaluation by measuring whether intervention is becoming institutionalised
• Provided insight on implementation problems in routine settings
• Enabled exploration of programme sustainability at different levels of care
• Identified risks and barriers to sustainability
• More work is needed to test with larger samples and different health promotion programmes
• Does not measure the processes leading to institutionalisation, only whether structural components are present or not present
• Wording and response options may need to be modified to fit with specific contexts
4. The advancing research and clinical practice through close collaboration model • Improved outcomes of believing in the value of evidence-based practice and increased reported use of evidence-based practice implementation behaviours
• Led to positive effects on nurses’ perceptions of organisational culture and readiness, beliefs and implementation, job satisfaction, group cohesion
• The model should include a cost component and patient outcomes to evaluate potential savings
5. Program sustainability assessment tool • Provided an overview of sustainability strengths and weaknesses
• Determined programme elements intended to sustain for the long term
• Enabled team to demonstrate accomplishments, tell their story, and build connections
• Facilitated the development of a vision and mission for the programme
• The brevity and simplicity of the tool may not capture the nuances of the setting and situation
6. Program sustainability index • Provided evidence of the supporting role of effective collaborations in sustainment across different service systems
• Provided a form of measurement
• Scales may require adaptation for use
7. NHS III sustainability model • Created an understanding of determinants of sustainability
• Found to be relevant for examining implementation processes across a range of clinical settings
• Aspects of the model’s design should be considered to include more user-friendly design
• Needs greater emphasis on the political and economic environment as well as patient and public engagement
8. Slaghuis’s framework and instrument for sustainability • Highlighted that strong relationships connect partnership functioning, synergy and the sustainability of innovative programmes in community care
• Identified short and long-term improvements in quality of chronic care delivery predicted programme sustainability
• Lack of relevance of specific subscales
9. Shell’s capacity for sustainability framework • Highlighted key strengths and weaknesses as well as levers within programmes • Some domains need further conceptual refinement
• Hard to categorise domains as entirely positive or negative due to the many nuances involved
10. Leffer’s conceptual framework for partnership and sustainability • Provided the structure for deeper understanding of distinctive views regarding the engagement processes and partner factors for effective collaboration
• Model constructs offered a platform to engage in dialogue with partners to gain context-specific insights
• Useful in guiding study to examine global health partnerships
• Model did not explore nurse partner factors, resources or sustainability; therefore, applicability of the model with other host partners, professions and contexts needs to be investigated
• Not generalisable to other countries outside of the United States
11. Gruen’s model of health-programme sustainability • Provided greater insight into the sustainability of interventions
• Provided insight into issues affecting programme sustainability and may foster development of a sustainability plan
• Not stated
12. Fleiszer’s framework for the sustainability of healthcare innovations • Aided in the identification of characteristics of programme sustainability • May benefit from further investigation to examine the long-term sustainability and discontinuation of different kinds of innovations in diverse settings
13. The sustainability analysis process • Supported participants to clarify the boundaries of their systems, define sustainability and identify sustainability indicators • Not stated
14. Conceptual framework for planning for sustainability of community-based health programs • Considered useful for analysis
• Provided an understanding of how programme sustainability is impacted by different components in and out of the community
• Framework could not address cultural specificity
15. Atun’s conceptual framework for analysing integration • Provided a systems lens for increasing integration and how this can help sustain effective interventions • Not stated
16. Practical, robust implementation and sustainability model • Provided valuable data that helped develop a detailed implementation plan and facilitated the implementation process • Not stated
17. Conceptual framework for sustainability of public health programs • Useful in explaining sustainability • Not able to explain all financial sustainability strategies