Sustainability - NHS England

1 Improvement Leaders GuideSustainability and its relationship with spread and adoption General improvement 3/5/07 6:05 pm Page 1 Sustainability and its relationship with spread and adoption 1 Improvement Leaders GuidesThe ideas and advice in these Improvement Leaders Guides will providea foundation for all your improvement work: Improvement knowledge and skills Managing the human dimensions of change Building and nurturing an improvement culture Working with groups Evaluating improvement Leading improvementThese Improvement Leaders Guides will give you the basic tools andtechniques: Involving patients and carers Process mapping, analysis and redesign Measurement for improvement Matching capacity and demandThese Improvement Leaders Guides build on the basic tools and techniques.

2 Working in systems Redesigning roles Improving flow Sustainability Technology to improve serviceYou will find all these Improvement Leaders Guides single person is enabled, encouraged andcapable to work with others to improve their part ofthe serviceDiscipline of Improvement in Health and Social 3/5/07 6:05 pm Page 12 Quality Improvement often takeslonger than expected to take hold andlonger still to become widely andfirmly established within anorganisationChris Ham: Professor of Health Policy and Management, Health Services Management Centre, University of 3/5/07 6:05 pm Page 2 Sustainability and its relationship with spread and adoption 3 Contents1.

3 What is this guide about and who is it for?42. An introduction to What it is and why is understanding sustainabilityimportant to service improvement? What does Sustainability actually mean? The New Improvement Wheel3. Key factors in sustainability164. Identifying things that can help support Sustainability The NHS Sustainability Model and Guide Engaging people to promote Practical top tips for improving Sustainability 5. How Sustainability links to spread 376. Frequently asked questions and answers 487. Jargon buster 528. Find out more 54 Useful reading and resources for more information and 3/5/07 6:05 pm Page 341 What is the guide about and who is it for?

4 Improvement is for everyone and like the other Improvement Leaders Guides inthe series, this is for anyone involved in health care, at any level, who wishes toimprove services and care for patients. Like the other guides it does not give allthe answers. As the title suggests, it is a guide to help you and links to relevantother parts of this series as well as references and websites. Information contained within the guides details good practice. The series is notdesigned to be a set of text books on improvement, but they introduce thedifferent elements of improvement work which will give you a good start andhopefully stimulate your interest to find out , theImprovement Leaders Guides form a set of principles for creating the bestconditions for improvements in healthcare.

5 What this guide will do is help youthink about ways to influence the Sustainability of your improvement so that itcan give the greatest benefit over its lifetime. You may have seen an earlier Improvement Leaders Guide on Sustainabilityand Spread. by The NHS Modernisation Agency. Since that was published, ourknowledge about Sustainability and spread has improved greatly. Severalexcellent pieces of work have been done on this topic and the NHSS ustainability Model and Guide (NHS Institute; 2006) has been how is this guide different? In the previous guide, Sustainability and spread were both considered in somedepth.

6 This guide concentrates mostly on Sustainability but we know thatspread is also very important, so this is dealt with separately in the section Howdoes Sustainability link to spread? You will see that the underlying thinking forsuccess in both Sustainability and spread is similar, so the ultimate aim is to useknowledge of the two in making things ever to use this guideWhether you are new to improvement work or have experience, this guide isnot designed to be read from end to end. It is a practical tool to help youwhether you are just thinking of an improvement or have a project underway.

7 It will give information on further reading and tools that will help youunderstand the sometimes confusing terminology as well as consideringfrequently asked questions. Whilst the information is not a guarantee that your improvement will besustained, it will help you consider and hopefully maximise the gains from yourimprovement 3/5/07 6:05 pm Page 4 Sustainability and its relationship with spread and adoption 5 Sustaining any profound changeprocess requires a fundamental shift inthinking. We need to understand thenature of growth processes and howto catalyse them.

8 But we also need tounderstand the forces and challengesthat impede progress, and to developworkable strategies for dealing withthese et al. (1999, ) 3/5/07 6:05 pm Page 562. An Introduction to Sustainability What is it and why is understanding it important in service improvement?Have you ever wondered why some changes or innovations seem successfuland others barely seem to get passed the planning stage? As an improvementleader, thinking about how your work can both continue after implementationand develop further is therefore a vital element of any improvement think about what you are trying to sustain, is itthe change you are implementing or an improved wayof thinking?

9 In its simplest form Sustainability can be seen as holding the gains and evolving as required . But Sustainability can also be complex and ambiguousleading to a variety of perspectives. The ambiguity is illustrated by the use ofdiffering terminology, often to mean the same thing. Think about what youunderstand by the following terms, chances are, they will conjure up a picturethat can mean the same as Sustainability :Stability?Stickability?Or ganisational change?Change becomes norm?Absorptive capacity?Embedded change? Continuing improvement?Irreversibility?You may be able to think of several more of your 3/5/07 6:05 pm Page 6 Sustainability and its relationship with spread and adoption 7 There are two major frustrations that are often encountered with Sustainability :The first is the improvement evaporation effector initiative decay.

10 This isthe effect of a lack of Sustainability . What happens is that where an improvementhas been implemented, often with much effort and resources, for a variety ofreasons, things slip back over time to how they were before all your hard studyEndoscopy in North West EnglandA Trust in the North West developed an open access endoscopy process had gone extremely well, GPs and hospital doctors workedtogether and agreed new referral forms and guidance to facilitatepatient booking for this service. They arranged for initial printing of asubstantial amount of paper copies of the forms and also provided theGPs with copies of the forms on a computer disc so that when they ranout they could print more as they needed them.