Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes
BACKGROUND: Implementation scientists and practitioners alike recognize the importance of sustaining practice change however post-implementation studies of interventions are rare. This is a protocol for the Sustainment Sustainability and Spread Study SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment sustained use) sustainability sustained benefits) and spread of evidence-based practice innovations in health care. Specifically this is a post-implementation study of an evidence-informed Care Aide-led facilitation-based quality-improvement intervention called SCOPE Safer Care for Older Persons in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba MB) Alberta AB) and British Columbia BC). Our study has three aims: i) to determine the role that adaptation/contextualization plays in sustainment sustainability and spread of the SCOPE intervention; ii) to study the relative effects on sustainment sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters” and a “no booster” condition and iii) to compare the relative costs and impacts of each booster condition.
METHODS/DESIGN: SSaSSy is a two-phase mixed methods study. The overarching design is convergent with qualitative and quantitative data collected over a similar time frame in each of the two phases analyzed independently then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017 in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters” and an untreated control group no booster) using pretests and post-tests of the dependent variables relating to sustained care and management practices and resident outcomes. Phase 2 will involve 31 trial sites in BC 17 units) and AB 14 units) nursing homes where the SCOPE trial concluded in May 2019.
DISCUSSION: This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.
Berta W. B. W. A. Cranley L. Doupe M. B. Ginsburg L. Hoben M. MacEachern L. Chamberlain S. Clement F. Easterbrook A. Keefe J. M. Knopp-Sihota J. Rappon T. Reid C. Song Y. Estabrooks C. A. 2019). Sustainment Sustainability and Spread Study SSaSSy): protocol for a study of factors that contribute to the sustainment sustainability and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes. Implement Sci141) 109. doi:10.1186/s13012-019-0959-2