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Sustainment definition and constructs
The input(s) continue to be delivered
Routinization and institutionalization of the inputs, while adapting and evolving, and the outputs on the part of the health provider and/or health consumer are maintained.
Ongoing capacity across levels to support the delivery of the inputs.
Outer context
Inner context
Ongoing use/provision
Adaptation and improvement
Monitoring
Reflection and team involvement
Routinization
Institutionalization
External support and communication
Partnership
Financial resources and funding
Leadership support and organizational climate
Organizational capacity
Training
Staff support, behavior, and attitudes
Level of Institutionalization Scale (LoIn) [12 ]
X
X
X
X
X
X
X
X
NHS Sustainability Model [67 ]
X
X
X
X
X
X
X
X
X
X
X
Measure of Sustainability of work practices [15 ]
X
X
X
X
X
X
X
X
NoMAD [14 ]
X
X
X
X
X
X
X
X
X
Program Sustainability Assessment Tool [45 ]
X
X
X
X
X
X
X
X
X
Program Sustainability Index (PSI) [56 ]
X
X
X
X
X
X
X
X
X
X
X
X
Note: Construct definitions: Ongoing use/provision The core components of the intervention continue to be delivered after a designated period of time, Adaptation and improvement The intervention is being adapted to fit the organization and improve the intervention, ideally based on monitoring, Monitoring The intervention benefits and intervention process (fidelity) being monitored and evaluated, Reflection and team involvement The intervention and its implementation are discussed with team members, Institutionalization The intervention is part of the norm of the organization and staff practice, Routinization The intervention is integrated into the operations of the organization and staff practice, External support and communication Political and/or community support for the intervention, including ongoing communication and demonstration of benefits, Partnership Collaboration and connections with community and external stakeholders, Financial resources and funding Stability of financial resources or funding, Leadership support and organizational climate Intervention fit with organizational goals and culture and leadership support for the intervention, Organizational capacity Resources and workforce, Staff support, attitudes, and behaviors Staff values, opinions, and actions, Training Adequate knowledge and skills, ideally acknowledging the need for ongoing training and training of new staff
