Skip to main content
SpringerLink
Log in
Book cover

Patient Safety and Quality in Pediatric Hematology/Oncology and Stem Cell Transplantation pp 101–121Cite as

Sustainability and Spread

  • Chapter
  • First Online:

  • 703 Accesses

Abstract

The sustainability and spread of quality improvement and/or patient safety innovations is often elusive, presenting continuous challenges to clinicians and healthcare leaders. Somewhere between 33 and 70% of all innovations are reportedly not sustained, and even fewer are spread beyond the original team, or to other units within an institution. In plain language, sustainability is defined as locking in progress, while continually building upon that foundation, while spread is the exchange of knowledge and experience on targeted work practices to achieve expected results. The literature supports the concept that sustainability is both multi-dimensional and multi-factorial and has several characteristics and pre-conditions. Two case studies are presented: one addressing the prevention of central line associated blood stream infections (CLABSIs) and the other dealing with recognition and treatment of febrile neutropenia (FN). Two key quality improvement tools, which assisted with the quality improvement efforts as well as the ultimate success of sustainability and spread, were the key driver diagrams and cascading responsibility charts. We recommend considering the characteristics and pre-conditions of sustainability and spread in advance of a quality improvement process rather than at the conclusion of the initial initiative.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Wiltsey-Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012;7:17–35.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fleiszer AR, Semenic SE, Ritchie JA, Richer M, Denis JL. The sustainability of healthcare innovations: a concept analysis. J Adv Nurs. 2015;71(7):1484–98.

    Article  PubMed  Google Scholar 

  3. Buchanan DA, Fitzgerald L, Ketley D, editors. The sustainability and spread of organizational change. Abingdon, Oxon: Routledge; 2007.

    Google Scholar 

  4. Carr, S. Editor’s notebook: a quotation with a life of its own. Patient safety & quality healthcare editor’s notebook. http://www.psqh.com/analysis/editor-s-notebook-a-quotation-with-a-life-of-its-own/. Accessed 1 July 2008.

  5. Scheirer MA. Is sustainability possible? A review and commentary on empirical studies of program sustainability. Am J Eval. 2005;26:320–47.

    Article  Google Scholar 

  6. Berwick DM. Disseminating innovations in health care. J Am Med Soc. 2003;289(15):1969–75.

    Google Scholar 

  7. Buchanan D, Fitzgerald L, Ketley D, Gollop R, Jones JL, et al. No going back: a review of the literature on sustaining organizational change. Int J Manag Rev. 2005;7(3):189–205.

    Article  Google Scholar 

  8. Greenhalgh T, Robert G, MacFarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004a;82(4):581–629.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Racine DP. Reliable effectiveness: a theory on sustaining and replicating worthwhile innovations. Adm Policy Ment Health Ment Health Ser Res. 2006;33:356–87.

    Article  Google Scholar 

  10. 5 Million Lives Campaign. Getting started kit: rapid response teams. Cambridge, MA: Institute for Healthcare Improvement; 2008. IHI.org.

  11. Greenhalgh, T., Robert, G., Bate, P., Kyriakidou, O., Macfarlane, F., & Peacock, R. (2004b). How to spread good ideas: a systematic review of the literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation. National Institute for Health Research (NIHR). http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0017/64340/FR-08-1201-038.pdf.

  12. Slaghuis S, Strating M, Bal R, Nieboer A. A measurement instrument for spread of quality improvement in healthcare. Int J Qual Health Care. 2013;25(2):125–31. doi:10.1093/intqhc/mzt016.

    Article  CAS  PubMed  Google Scholar 

  13. Rogers EM. Diffusion of innovations. New York: Free Press; 1995.

    Google Scholar 

  14. Osbourne SP. Naming the beast defining and classifying service innovations in social policy. Hum Relat. 1998;30:1133–54.

    Google Scholar 

  15. Fraser SW, Burch K, Knightly M, Osborne M, Wilson T. Using collaborative improvement in a single organisation; improving anticoagulant care. Int J Healthcare Qual Assur. 2002;15:152–8.

    Article  Google Scholar 

  16. Wilson MZ, Rafferty CR, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. Am J Infect Control. 2014;42:1157–60.

    Article  PubMed  Google Scholar 

  17. Marschall, J., Mermel, L., Fakih, M., Hadaway, L., Kallen, A., et al. (2014). Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol, 35, 753–771. (On behalf of The Society for Healthcare Epidemiology of America).

    Google Scholar 

  18. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2011;52(4):e56–93.

    Article  PubMed  Google Scholar 

  19. Lehrnbecher T, Phillips R, Alexander S, et al. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol. 2012;30(35):4427–38.

    Article  PubMed  Google Scholar 

  20. Merriam-Webster. Sustainability. Springfield: Merriam-Webster Online Dictionary; 2013.

    Google Scholar 

  21. Rogers EM. Diffusion of innovations. New York: Free Press; 2003.

    Google Scholar 

  22. Bowman CC, Sobo EJ, Asch SM, Gifford AL. Measuring persistence of implementation: QUERI series. Implement Sci. 2008;3:3–21.

    Article  Google Scholar 

  23. Scheirer MA, Dearing JW. An agenda for research on the sustainability of public health programs. Am J Public Health. 2011;101(11):2059–67.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stetler CB, Ritchie JA, Rycroft-Malone J, Charns MP. Leadership for evidence-based practice: strategic and functional behaviors for institutionalizing EBP. Worldviews Evid Based Nurs. 2014;11(4):219–26.

    Article  PubMed  Google Scholar 

  25. Davies B, Edwards N. Sustaining knowledge use. In: Straus SE, Tetroe J, Graham ID, editors. Knowledge translation in health care: moving from evidence to practice. West Sussex: Wiley-Blackwell; 2013. p. 165–73.

    Google Scholar 

  26. Mancini JA, Marek LI. Sustaining community-based programs for families: conceptualization and measurement. Fam Relat. 2004;53(4):339–47.

    Article  Google Scholar 

  27. Gruen RL, Elliott JH, Nolan ML, Lawton PD, Parkhill A, McLaren CJ, Lavis JN. Sustainability science: an integrated approach for health-programme planning. Lancet. 2008;372(9649):1579–89.

    Google Scholar 

  28. Johnson K, Hays C, Center H, Daley C. Building capacity and sustainable prevention innovations: a sustainability planning model. Eval Program Plann. 2004;27(2):135–49.

    Article  CAS  Google Scholar 

  29. Bevan H, Christian D, Cottrell K, Easton J, Fraser S, Green L, Green R, Godfrey-Harris L, Hargadon J, Kennedy R, Ketley D, Kulkarni M, McBride M, Maher L, Mudd D, O’Neil S, Penny J, Plsek P, Riley N, Rogers H. Improvement leaders’ guide to sustainability and spread. Ipswich: N. H. S Modernization-Agency; 2002.

    Google Scholar 

  30. Damanpour F, Gopalakrishnan S. Theories of organizational structure and innovation adoption: the role of environmental change. J Eng Technol Manag. 1998;15:1–24.

    Article  Google Scholar 

  31. Wejnert B. Integrating models of diffusion of innovations: a conceptual framework. Annu Rev Sociol. 2002;28:297–326.

    Article  Google Scholar 

  32. Mowatt G, Thomson MA, Grimshaw J, Grant A. Implementing early warning messages on emerging health technologies. Int J Technol Assess Health Care. 1998;14:663–70.

    Article  CAS  PubMed  Google Scholar 

  33. NHS Modernisation Agency. The improvement leader’s guide to spread and sustainability. London: Department of Health; 2003.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Texas Children’s Cancer and Hematology Centers,Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Mona D. Shah MD, MS (Associate Clinical Director)

  2. Texas Children’s Hospital, Houston, TX, USA

    Jacqueline R. Ward MSN, RN, NE-BC (Vice President of Nursing)

  3. Texas Children’s Hospital, Professor & Section Head, Academic General Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Angelo P. Giardino MD, PD (SVP/Chief Quality Officer)

Authors
  1. Mona D. Shah MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacqueline R. Ward MSN, RN, NE-BC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelo P. Giardino MD, PD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mona D. Shah MD, MS .

Editor information

Editors and Affiliations

  1. Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Christopher E. Dandoy

  2. Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Aurora, Colorado, USA

    Joanne M. Hilden

  3. Boston Children’s Cancer and Blood Disorders Center, Dana-Farber, Boston, Massachusetts, USA

    Amy L. Billett

  4. Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA

    Brigitta U. Mueller

Appendices

Appendix 1: Case 1: Central Line Associated Blood Stream Infection (CLABSI)

figure a
figure b
figure c

Appendix 2: Febrile Neutropenia (FN, Neutropenic Fever)

figure d
figure e
figure f

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Shah, M.D., Ward, J.R., Giardino, A.P. (2017). Sustainability and Spread. In: Dandoy, C., Hilden, J., Billett, A., Mueller, B. (eds) Patient Safety and Quality in Pediatric Hematology/Oncology and Stem Cell Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-53790-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-53790-0_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-53788-7

  • Online ISBN: 978-3-319-53790-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation