Translating technical improvements into behavioural ones the sustainability challenge
There is a paucity of papers focused on the sustainability of improvement projects. In addition, the authors and the VA are to be congratulated on sharing what are less-than-positive results so we can all learn.
The quality improvement collaborative (QIC) process is excellent in raising awareness of issues, training staff in QI techniques and in mobilising action to improve. With all methods there are some gains and losses. The positive contribution of the QIC process needs to be balanced with the lack of deep behavioural or system change - and this matters when it comes to sustainability. The continual focus on technical measurements in QIC allows participants to displace the need for behavioural changes. Also, because the process is team focused, rather than organisational focused, system changes are difficult to make.
Just because sustainability drops off after the program, doesn't mean it isn't a good program. It may, however, mean that to gain sustainability additional parallel support is required or the QIC needs to be redesigned in content and structure.
Conflict of Interest:
I operate as a consultant in healthcare.