Overview, Learning Objectives, Reading Assignments, and Resources
Module 10: Planning for Sustainment
An understanding of how value champions can incorporate plans for sustainment into every aspect of their overuse reduction initiative is provided in this module.
The purpose of this module is to provide participants with an understanding of how health care organizations sustain improvements in the care they deliver, and how they as value champions can incorporate plans for sustainment into every aspect of their overuse reduction initiative. Planning for sustainment begins at the beginning of an initiative: assume that you will be successful in reducing the use of your targeted overused test or treatment, what will you need to ‘hardwire’ into your planned interventions so that the reduction is sustained after you move on to other overused services? What do we know about how clinical settings and health care organizations sustain such efforts?
- Discuss how the characteristics of an intervention designed to reduce the use of an overused service might contribute to sustained reductions in that service.
- Give examples of how characteristics of organizational setting might influence sustainability and what strategies might be used to leverage them for sustainment.
- Explain how and why early planning for sustainability is important when Taking Action on Overuse.
This article tells the remarkable story of the experience of both the results and the sustainment in the initial effect over time of a multi-faceted intervention to reduce this low-value care service. For this assignment please read both the article and the supplement that described the intervention in more detail.
- Citation: Mafi JN, Godoy-Travieso P, Wei E, et al. Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System. JAMA Intern Med. 2019;179(5):648–657. doi:10.1001/jamainternmed.2018.8358
This is an insightful examination of a health system's quality improvement intervention to decrease the use of low-value vitamin D screening and assesses which components of the intervention had the greatest effects on effectiveness and sustainability.
- Citation: Petrilli CM, Henderson J, Keedy JM, et al. Reducing Unnecessary Vitamin D Screening in an Academic Health System: What Works and When. Am J Med. 2018;131(12):1444-1448. doi:10.1016/j.amjmed.2018.06.025.
This 13-minute video provides an overview of our understanding of the factors that influence sustainability, discusses several frameworks that are commonly used to both plan for and assess sustainability, and discusses currently unanswered questions about sustainability.
- Citation: Shelton et al. Conceptual frameworks and planning for sustainability. YouTube video: https://www.youtube.com/watch?v=uel0vKMcjAM.
These tools help you rate and assess the sustainability capacity of your program or clinical practice. Using them early in your overuse reduction initiative can help you modify your action plans and project timeline activities to improve the likelihood that any reduction in the use of an overused service will be sustained.
- Citation: Program/Clinical Sustainability Assessment Tool. https://www.sustaintool.org/
This guide provides practical advice on how you might increase the likelihood of sustainability for your project.
- Citation: NHS Sustainability Model and Guide. https://improvement.nhs.uk/resources/Sustainability-model-and-guide/