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

Abstract

Background Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. Methods A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. Results This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. Conclusions This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. Trial Registration This review was registered on the PROSPERO database CRD 42016040081 in June 2016.

Factors that foster and challenge the sustainability of departmental health insurance units in Senegal

“…When we compare the various sustainability factors proposed by the participants in the specific context of this study, similarities with the international evidence become evident (Braithwaite et al, 2020; Lennox et al, 2020). Thus, we find the usual constructs of sustainability factors: collective action, integration, financial stability, political support, communication, leadership, staff involvement and attitudes, expected benefits, adaptation, community participation, ownership, partnership, effectiveness, and response to a need, organizational capacity, etc.…”

Trialists perspectives on sustaining, spreading, and scaling-up of quality improvement interventions

“…Tools such as the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) [ 38 ] may be useful to understand and monitor adaptations. When considered with other literature [ 2 , 8 , 37 , 39 ], this work leads to several questions including, what skills are needed to facilitate adaptation? With the need for a strong business case, how can researchers and community partners be supported to develop this case?…”

Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients

“…Our aims are designed to deepen commitment [ 44 ] to sustain EBP use by including measures that matter to different key constituencies including employees (e.g., workgroup functioning, job satisfaction), health system leaders (increased use of EBPs), and patients (e.g., reduction in PIMs) [ 6 , 7 , 45 ]. The combination of implementation strategies with measures that matter is designed to empower teams and individuals to increase meaning and purpose of their work, focused on the health and well-being of the Veterans we serve.…”

“…Lack of sustainment may be particularly challenging for clinics that start off with low rates of EBP use compared to other clinics in the system [ 5 ]. The problem of implementation sustainability is due, in part, to the fact that many implementation efforts are short in duration with limited follow-up support [ 6 , 7 ]. Strategies that change the habits of practitioners—either by changing the system within which they practice or by providing insights about how to make doing the EBP simpler and more meaningful—are likely to be more effective [ 8 ].…”