What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London

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Abstract

Objectives

Although improvement initiatives show benefits to patient care, they often fail to sustain. Models and frameworks exist to address this challenge, but issues with design, clarity and usability have been barriers to use in healthcare settings. This work aimed to collaborate with stakeholders to develop a sustainability tool relevant to people in healthcare settings and practical for use in improvement initiatives.

Design

Tool development was conducted in six stages. A scoping literature review, group discussions and a stakeholder engagement event explored literature findings and their resonance with stakeholders in healthcare settings. Interviews, small-scale trialling and piloting explored the design and tested the practicality of the tool in improvement initiatives.

Setting

National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL).

Participants

CLAHRC NWL improvement initiative teams and staff.

Results

The iterative design process and engagement of stakeholders informed the articulation of the sustainability factors identified from the literature and guided tool design for practical application. Key iterations of factors and tool design are discussed. From the development process, the Long Term Success Tool (LTST) has been designed. The Tool supports those implementing improvements to reflect on 12 sustainability factors to identify risks to increase chances of achieving sustainability over time. The Tool is designed to provide a platform for improvement teams to share their own views on sustainability as well as learn about the different views held within their team to prompt discussion and actions.

Conclusion

The development of the LTST has reinforced the importance of working with stakeholders to design strategies which respond to their needs and preferences and can practically be implemented in real-world settings. Further research is required to study the use and effectiveness of the tool in practice and assess engagement with the method over time.

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Most cited references 22

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A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice.

Adrianne C Feldstein, Russell E. Glasgow (2008)

Although numerous studies address the efficacy and effectiveness of health interventions, less research addresses successfully implementing and sustaining interventions. As long as efficacy and effectiveness trials are considered complete without considering implementation in nonresearch settings, the public health potential of the original investments will not be realized. A barrier to progress is the absence of a practical, robust model to help identify the factors that need to be considered and addressed and how to measure success. A conceptual framework for improving practice is needed to integrate the key features for successful program design, predictors of implementation and diffusion, and appropriate outcome measures. A comprehensive model for translating research into practice was developed using concepts from the areas of quality improvement, chronic care, the diffusion of innovations, and measures of the population-based effectiveness of translation. PRISM--the Practical, Robust Implementation and Sustainability Model--evaluates how the health care program or intervention interacts with the recipients to influence program adoption, implementation, maintenance, reach, and effectiveness. The PRISM model provides a new tool for researchers and health care decision makers that integrates existing concepts relevant to translating research into practice.

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How long does biomedical research take? Studying the time taken between biomedical and health research and its translation into products, policy, and practice

Stephen R Hanney, Sophie Castle-Clarke, Jonathan Grant … (2015)

Background The time taken, or ‘time lags’, between biomedical/health research and its translation into health improvements is receiving growing attention. Reducing time lags should increase rates of return to such research. However, ways to measure time lags are under-developed, with little attention on where time lags arise within overall timelines. The process marker model has been proposed as a better way forward than the current focus on an increasingly complex series of translation ‘gaps’. Starting from that model, we aimed to develop better methods to measure and understand time lags and develop ways to identify policy options and produce recommendations for future studies. Methods Following reviews of the literature on time lags and of relevant policy documents, we developed a new approach to conduct case studies of time lags. We built on the process marker model, including developing a matrix with a series of overlapping tracks to allow us to present and measure elements within any overall time lag. We identified a reduced number of key markers or calibration points and tested our new approach in seven case studies of research leading to interventions in cardiovascular disease and mental health. Finally, we analysed the data to address our study’s key aims. Results The literature review illustrated the lack of agreement on starting points for measuring time lags. We mapped points from policy documents onto our matrix and thus highlighted key areas of concern, for example around delays before new therapies become widely available. Our seven completed case studies demonstrate we have made considerable progress in developing methods to measure and understand time lags. The matrix of overlapping tracks of activity in the research and implementation processes facilitated analysis of time lags along each track, and at the cross-over points where the next track started. We identified some factors that speed up translation through the actions of companies, researchers, funders, policymakers, and regulators. Recommendations for further work are built on progress made, limitations identified and revised terminology. Conclusions Our advances identify complexities, provide a firm basis for further methodological work along and between tracks, and begin to indicate potential ways of reducing lags. Electronic supplementary material The online version of this article (doi:10.1186/1478-4505-13-1) contains supplementary material, which is available to authorized users.

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Lean healthcare: rhetoric, ritual and resistance.

Justin J. Waring, Simon Bishop (2010)

This paper presents an ethnographic account of the implementation of Lean service redesign methodologies in one UK NHS hospital operating department. It is suggested that this popular management 'technology', with its emphasis on creating value streams and reducing waste, has the potential to transform the social organisation of healthcare work. The paper locates Lean healthcare within wider debates related to the standardisation of clinical practice, the re-configuration of occupational boundaries and the stratification of clinical communities. Drawing on the 'technologies-in-practice' perspective the study is attentive to the interaction of both the intent to transform work and the response of clinicians to this intent as an ongoing and situated social practice. In developing this analysis this article explores three dimensions of social practice to consider the way Lean is interpreted and articulated (rhetoric), enacted in social practice (ritual), and experienced in the context of prevailing lines of power (resistance). Through these interlinked analytical lenses the paper suggests the interaction of Lean and clinical practice remains contingent and open to negotiation. In particular, Lean follows in a line of service improvements that bring to the fore tensions between clinicians and service leaders around the social organisation of healthcare work. The paper concludes that Lean might not be the easy remedy for making both efficiency and effectiveness improvements in healthcare.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2017

Publication date (Electronic): 24 September 2017

Volume: 7

Issue: 9

Electronic Location Identifier: e014417

Affiliations

[1 ] departmentDepartment of Medicine , CLAHRC for Northwest London , London, UK

[2 ] departmentDepartment of Medicine , Imperial College London , London, UK

[3 ] NIHR CLAHRC for Northwest London , London, UK

[4 ] departmentDepartment of Public Health and Primary Care , Imperial College London , London, UK

Author notes

[Correspondence to ] Dr Laura Lennox; l.lennox@ 123456imperial.ac.uk

Author information

Derek Bell http://orcid.org/0000-0002-9944-1097

Article

Publisher ID: bmjopen-2016-014417

DOI: 10.1136/bmjopen-2016-014417

PMC ID: 5623390

PubMed ID: 28947436

SO-VID: df890c62-3b5f-4d0d-a7b3-dc2beb5588c3

License:

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

History

Date received : 23 September 2016

Date revision received : 11 July 2017

Date accepted : 25 July 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;

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ScienceOpen disciplines: Medicine

Keywords: quality improvement,tool,sustainability

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ScienceOpen disciplines: Medicine

Keywords: quality improvement, tool, sustainability

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What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London

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Abstract

Objectives

Design

Setting

Participants

Results

Conclusion

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Most cited references 22

A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice.

How long does biomedical research take? Studying the time taken between biomedical and health research and its translation into products, policy, and practice

Lean healthcare: rhetoric, ritual and resistance.

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