So, let's begin with goals and objectives. My overall goal is to highlight the importance of planning for project sustainment from the inception of the project. Specific objectives: By the end of this lecture, you should be able to define sustainment. Recognize the reality of risk from project failure. Identify attributes of successful projects. Explain the importance of identifying and using sustainable measures. Explain the importance of identifying appropriate data sources including people and more material resources, and appreciate the importance of planning to embed and sustain your change effort. So, here's a dictionary definition of sustainability. The ability to be maintained at a certain rate or level. The avoidance of the depletion of natural resources in order to maintain an ecological balance. And even this definition I think it's fairly appropriate for, what's going on in healthcare? We have our own delicately balanced ecology. Sustainability in healthcare occurs when safety innovation is transformed from a project to becoming part of daily work and daily workflow. Sustainability happens when improvements in patient outcomes attributed to new practices are maintained after the initial project implementation ends. Essential to this is providers who share their expertise and provide ongoing support to others to execute those changes and to continue to do so. Sustainability has happened when the project is no longer described as change but rather, this is how we do things here. Here's one model from Shediac and Rizkalla that comes from 1998 which I like quite a bit. Well, we begin probably at the top with the project design and factors that are inherent to the implementation. How do we do it? And we sort of think that's the whole story. But before that there are factors in the broader community that dictated implicitly what we do, limited what we do. There are also factors within the organization that certainly influence us. Together, we hope to achieve programs sustainability. We hope to maintain health benefits certainly. We would like to institutionalize the program within the organization. And we would like to build capacity within the community to allow that to happen. The IHI a few years ago created a guide or a white paper on sustaining improvement. This was based on their review of literature both theoretical and practical. And their model focuses on daily work for frontline managers and staff. Key elements of their model are performing daily huddles of healthcare workers to discuss tasks that needs to be done. The use of visual boards at the frontline, so people can see how they're progressing, problem solving, and escalation protocols, so that if things are not working, they can move up to the appropriate level where the problem can be fixed. And the integration of aims and priorities into the entire plan. A third model is the trip model that is for translating research into practice. Perhaps more appropriately these days translating evidence into practice, since not everything we're doing uses research evidence per se. You've already heard a little bit about this in an earlier lecture. Crucial to this model are first of all, assembling the right team to do the work, summarizing the available evidence, understanding barriers that you may confront, planning ahead, and then for ease, engaging first, then educating, then executing the plan, and then evaluating what's occurred.
