BackgroundThe introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research.MethodsTwo coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized.ResultsAlthough "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves.ConclusionsClearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues su...

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Innovations in health care account for some of the most dramatic improvements in population health outcomes in the developed world as well as for a nontrivial proportion of growth in expenditures. Provider organizations are the adopters of many of these innovations, and understanding the factors that inhibit or facilitate their diffusion to and possible disengagement from these organizations is important in addressing cost, quality, and access issues. Given the importance of these issues, the purpose of this article is to (1) create a comprehensive census of studies examining the adoption of and disengagement from innovations in health care provider organizations; (2) organize these studies into an inductively derived classification scheme; (3) assess the studies' strengths and weaknesses; and (4) reflect on the implications of our review for future research.

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Organization theory is, as the title of this special issue suggests, at a crossroads. At a time when the world of and around organizations is changing very fast, and when the need to invent new approaches to organizations and their management is apparent, organization theory is challenged either to encompass these changes and contribute to their elucidation or be viewed as a quaint, but largely irrelevant, enterprise. This paper is one response to the challenge defined above. In it, we seek to analyze how and why one particular organization, characterized by a highly unorthodox management approach and strong performance, developed as it did. The innovative approach to management coupled with high performance is central to the question of relevance.

This article offers a lively and spirited debate on the pros and cons of relating research to practice. The authors' goal is to illuminate fundamental issues in the debate in detail, consider a variety of prescriptions, and then come to a mindful conclusion about a course of action. The article begins with a point—counterpoint debate to make sure that scholars fully understand the issues in play. Mike Tushman starts off by arguing for an emic approach. He believes that scholars are most effective when they closely work with management and organizations. John Kimberly counters with an etic perspective. He argues that scholars need to keep their distance. Two attempts to make sense of the many issues raised in the debate close the article. First, Bill Starbuck steps back and offers his ideas about what the debate means for continuing scholarship. And then Sue Ashford brings the exchange to a conclusion. She draws on her many years in the dean's office to offer her wisdom about how to best organize business schools in the coming years. In the end, the authors know that there will be nearly as many errors as trials when the world's business schools determine how best to proceed. Their aim here is to minimize the effects of these errors. If and when schools do err, the authors want to be sure that they do it with their eyes wide open.