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Sustaining Improved Outcomes

Sustaining improved outcomes means that the outcomes that you have achieved are maintained for as long as you want them to be. It is important that you define exactly what results you want to sustain and over what time period you want them to be sustained. Both the results and the time frame should be specific and measurable and should be used as the basis for sustainability activities. For illustrative purposes, an example would be:

Our organization will sustain a 25% increase in sales (from $150,000 in 2010 to $187,500) using Supplemental Nutrition Assistance Program (SNAP) benefits/food stamps at all of the farmer’s markets in the Philadelphia region for at least two years.

Different Types of Sustainability

There are many ways to define and address sustainability. This toolkit focuses on the sustainability of improved outcomes and provides a framework, guidance, and tools for how to do that.

There are two additional types of sustainability that are important but not directly addressed on this website or in the toolkit. These are the sustainability of a specific program and/or service and the sustainability of an organization.

One of the most important distinctions between these types of sustainability is in regards to funding. Program and organizational sustainability often require a primary focus on funding. Sustaining ongoing programs, such as job skills classes or free health screenings, usually need funding to pay for the staff, supplies, and materials. Sustaining an organization requires funding to pay for staff, rent, equipment, and other ongoing expenses.

In contrast, ongoing funding is not necessarily needed to sustain improved outcomes. For example, if a project at a community health center resulted in an increased number of providers giving advice to quit to their patients who smoke, this improved outcome should not need continuous funding. There will be a need during the implementation phase for funding to pay for trainings and systems changes. However, if it was implemented in a sustainable way, there will be no need for these types of costs once the improvement has been successfully integrated into regular health center operations.

This distinction is important because there is a strong tendency among those addressing sustainability to focus on how to obtain more funding. However, in regards to sustaining improved outcomes, a primary focus on funding will take away from the attention on those factors that are more likely to impact the sustainability of the results.

12 Factors for Sustaining Improved Outcomes

In Sustaining Improved Outcomes: A Toolkit, the authors provide 12 factors that can contribute to sustaining improved outcomes and related tools for assessing and planning for sustainability. Although the 12 factors and tools were developed for sustaining improved outcomes, they likely can assist with program and organizational sustainability.

The 12 factors are:

  • Perceived value
  • Monitoring and feedback
  • Leadership
  • Staff
  • Organizational infrastructure
  • Organizational fit
  • Community fit
  • Government policy
  • Spread
  • Partners
  • Models
  • Funding

These factors were developed from a number of sources. The primary source was a qualitative study conducted by the Primary Care Development Corporation and funded by the Commonwealth Fund. Both authors of this toolkit worked with a research team on the study. That study examined factors that contribute to sustaining and spreading quality improvements in healthcare settings.

Those factors were then compared with published studies and available reports on sustainability. (See Research section.) One of the main publications used was the Sustainability: Model and Guide, which was produced by the National Health Services’ Institute for Innovation and Improvement in the United Kingdom and was previously available on the Internet.

The framework also has been influenced by more than 20 workshops that the authors have conducted on sustainability over the past three years. The feedback from workshop participants has been instrumental in helping refine, narrow, and clarify the 12 factors and tools.

Toolkit Funders

The development of Sustaining Improved Outcomes: A Toolkit was funded by Asian Pacific Islander American Health Forum, the Community Health Foundation of Western and Central New York, and the New York State Health Foundation.