gms | German Medical Science

Background: Failure to sustain guideline-based organizational change at two-years is 41-70% with limited evaluation of prospective theory-based sustainability-oriented guideline implementation. The NHS sustainability model was developed by 250 experts in the UK with 10 factors clustered about process, staff and organizational determinants.

Objectives: To measure the impact of sustainability-oriented guideline implementation on patient care in hospitals, primary care and home care services annually for three years.

Methods: A longitudinal pre-post mixed methods design with nine health care organizations implementing guidelines (breastfeeding, delirium-dementia-depression, fall prevention, pain management, smoking cessation, wound care). Intervention included interviews (leaders, care providers n=90), focus groups (inter-professional steering committee n=83), sustainability action planning at monthly mentoring teleconferences, and provision of annual site-specific sustainability scores and patient outcomes.

Results: Baseline sustainability scores ranged from 35.4-77.3% (mean 66.4%). Infrastructure for sustainability was low at 56.8%. Participants reported that site-specific scores with illustrative quotes identified perceived barriers of providers, teams and organizational systems. Selected priority process and patient outcomes improved at 7 of 9 sites (p≤.05, and/or clinically relevant change of ≥15%) from baseline.

Discussion: The mean NHS model sustainability score (66.4%) is higher than the recommended 55% for launching implementation initiatives. Low scores were useful to identify factors that needed further attention. Improvements in priority patient outcomes were promising.

Implications: Guideline users need to think beyond 1 year pilot implementations with inter-professional perspectives to maximize adaptability to the context and minimize implementation erosion over time.