PHASE 4: SUSTAINMENT

 

It is common that an implementation is not sustained once the implementation team has left or dissolved.  Whether an implementation can be sustained is largely related to if it can be normalised into routine practice; and if the needs can be met.  This requires a number of inner or internal factors and outer or external factors. Not all factors are relevant to all implementations. At a local level, often inner factors are more important and have direct impact on the success of implementation.

Outer Factors

  • Leadership
    • This is related to external leadership, such as input from the government.
  • Link to other organisations
    • This refers to the pressure from external organisations, such as if other hospitals are also doing this.
  • Funding
    • Is this implementation costly? Is there funding available? This is essential for a new intervention to be used.
    • Points to consider: Is acupuncture / acupressure cost neutral? Does it reduce anti-emetic use, or shorten the time in Recovery or hospital?

Inner Factors

 

  •  Leadership
    • Support from the leadership to this implementation is essential.
    • Solution: engaging leadership from Phase 1 is necessary for ensuring support is continued.
    • Solution: provide audit report to leadership regularly, and
    • Solution: align the outcome of this implementation with organisational missions and goals.
  • Fidelity
    • Is the acupuncture / acupressure practised as it is intended to be? Fidelity is a major issue in any implementation. Over time, for various reason, acupuncture / acupressure may not be practised at it was designed.
    • An example: In an acupressure for PONV study, the SeaBand was found to be displaced during the peri-operative period and was placed below PC6 on the wrist crease. This happened after the band was removed then reapplied, or those who delivered the intervention forgot the precise location.
    • Solution: onsite monitor. A member periodically checks the application of wristband on PC6 post-surgically. Data will be fed back to all staff involved in the process, including anaesthetists and nurses at Day Procedure Unit, Theatre, Recovery Unit, and on the ward.
    • Solution: make education material visible, easily accessed and regularly assessed per other routine practice;
    • Solution: regular education sessions per how other skills are maintained or checked;
  • Staffing / support coaching
    • For the above-mentioned reason, continuing support to staff, both in terms of education and time, is necessary.
    • Solution: identifying one or two enthusiastic champions at each work unit.
    • Solution: staff are reminded by managers.
    • Solution: make education material visible, easily accessed and regularly assessed per other routine practice.
Back to Top