Background: In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these efforts. Methods: We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN initiatives. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results: We conducted thirty realist interviews in two cases and found four important mechanisms facilitating sustainability: the use of a collaborative approach audit & feedback, the informal leadership role, and patient stories. Informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the initiative. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of initiative sustainability. Patient stories demonstrated the initiatives’ impact on patient outcomes, motivating staff to want to continue doing the initiative, and increasing the likelihood of its sustainability. Conclusions: There are important contextual factors and mechanisms within sustainment processes that may apply to systems change implementers. Our research revealed the causal relationship between implementation and sustainability and how outcomes from implementation shape sustainability contexts. Future work is needed to evaluate the effectiveness of informal leadership, learning collaboratives, audit-feedback, and patient stories as sustainability interventions, to generate better guidance on planning sustainable improvements with long term impact.
Background Patient stories are a knowledge translation (KT) strategy that embody the patient experience. Patient stories are used to inform healthcare policy, delivery, and patient engagement, and have many positive impacts on the uptake of evidence-based interventions (EBIs) in healthcare. However, there is little evidence on the use and influence of patient stories for the long-term sustainability of EBIs. This study aims to understand how patient stories influenced the sustainability of two scaled EBIs in healthcare in the context of Alberta Health Services, Canada. Methods We conducted a secondary analysis of 20 qualitative interviews from the realist evaluation: Contextual factors and mechanisms that influence sustainability: A realist evaluation of two scaled, multi-component interventions. We employed a thematic analysis of the interview data. Results Patient stories positively influenced the sustainability of two EBIs by: 1) conveying the “why” behind the intervention, 2) motivating and encouraging staff to continue to engage with the intervention long-term, and 3) facilitating the spread and scale of the EBI. Success stories from patients and their families were especially impactful because they reflected positive outcomes of the EBI. Participants emphasized that patient stories should be positive in nature and be continually shared through different modalities (e.g., digital stories) for sustainability efforts. Conclusions The idea of patient stories as a KT strategy for sustainability is still nascent and requires more effectiveness and evaluation research. Our findings demonstrate how patient stories can facilitate the sustainability of EBIs in healthcare. In particular, our findings show how sharing stories digitally or through learning collaboratives and online toolkits, facilitates sustainability because digital stories can be saved and continually distributed to a wide audience at any time. Understanding the potential of patient stories as a KT strategy for sustainability will contribute to the long-term success of EBIs, thus improving healthcare quality.
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