The Expert:

Dr Lynne Maher

Dr Lynne Maher is the director of innovation at Ko Awatea. She is a recognised international leader in healthcare improvement and innovation, with an extensive career ranging from critical care nursing to operational and board posts at local and national level. Dr Maher has published guidance on innovation, patient experience, improvement and change management, and has worked with a wide range of healthcare organisations and charities to provide advice in these fields.

Their View:

Sustaining change is one of the biggest challenges in quality improvement. Studies estimate that up to 70 per cent of change initiatives fail to stick.[1],[2]

How, then, can you maximise the sustainability of your quality improvement project? This article shares eight tips for sustainability factors that are often overlooked.

1. Plan for sustainability from the start 
If you leave it to the end of your project to start thinking about sustainability, it will be too late to influence many of the factors that determine whether a project will have a long-term impact. While you don’t need to do everything right at the beginning, the first five points in this article should be actioned early. As your project progresses you will need to pay attention to the last three points and plan how and when to address them.

A project checklist, task sheet or Gantt chart can be used to do this. Make sure sustainability is included, and create a task checklist to cover the key factors that influence it.

2. Consider communication and engagement 
Very early on in the process, you should have a clear understanding of who you need to communicate and engage with, how to reach those people, and the key messages you want to get across.

Focus on why the work is important and what the anticipated benefits will be. Articulate the intended and realised benefits of your project as you progress. Remember to communicate the benefits your project will deliver for staff as well as for patients and also the ward, department or organisation as a whole. Change can be difficult, and to get staff on board you need to help them to understand the full range of benefits including how your project will benefit them.

Making staff feel part of the process is also key to engagement. People will support what they helped to create. Rather than simply telling them what you’re going to do, actively seek their thoughts, ideas and involvement from the beginning and throughout the project.

3. Engage senior leaders
The involvement of senior clinical and managerial leaders is invaluable for securing organisational support and resources, spreading the word about what you’re doing, and negotiating the inevitable barriers. Using a quality improvement compact, which is a tool for project teams to create a common understanding with senior leaders about role expectations and how best to work together on a project, will help to make the relationship a success.

4. Align with organisational strategy
Many people don’t pay enough to attention to aligning their work with organisational strategy. If a project is a good fit with organisational strategy and priorities, it is much more likely to secure the support of senior leaders and to survive any disruption caused by other things happening in the organisation.

5. Establish sustainable measures
Teams often collect a whole host of measures during a project. You can’t keep collecting a wide range of measures once the project has formally ended, so think about how the team or system you’re working in will understand that gains are still being made. Look at the measures the organisation is already collecting and plan which could be used, or adjusted without difficulty, to demonstrate ongoing benefits.

6. Plan for resource needs 
If you’re working on a project that involves testing new equipment or technology, take steps to ensure continued access to the equipment you need after the project has ended. For example, if you’re using loaned or hired equipment during the project period and you start to see positive results, think early on about how to obtain the equipment long-term. This means you need to take account of the financial year and competing for budget.

7. Plan for scale-up 
Your project may involve developing a new process or system that requires people to acquire new knowledge or skills. If so, you need to work with your organisation’s human resources or building capability team to develop a training programme for all the people who will need those skills. Plan ahead so that training can occur before your project finishes, or promptly afterwards. If there is a delay after the project ends while a training programme is developed, the likelihood that the new way of working will remain is minimal and you may encounter safety or governance challenges

8. Anticipate impact on wider stakeholders
Consider whether your new way of working could have an impact on organisational policies, procedures, job descriptions or other administrative factors. If so, ensure you engage with affected stakeholders in a timely manner to anticipate and mitigate any potential delays or barriers.


1. Fleiszer AR, Semenic SE, Ritchie JA, Richer M-C, Denis J-L. The sustainability of healthcare innovations: a concept analysis. J Adv Nurs. 2015; 71(7): 1484-1498.
2. Beer M, Nohria N. Cracking the code of change. Harvard Business Review. 2000; 78: 133-141, 216.

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