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The dynamic sustainability framework

Addressing the paradox of sustainment amid ongoing change

Bibliographic Data

ID23324063
AuthorsDavid Chambers (0009-0002-1413-7801, National Institute of Mental Health, corresponding author), David A Chambers (0000-0002-5991-2827), Russell E Glasgow (0000-0003-4218-3231, University of Colorado Denver), Kurt C Stange (0000-0002-2189-0191, Case Western Reserve University)
Year2013
Volume8
Issue1
Pages117-117
Publication date2013-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueImplementation Science (JOURNAL)
Journal identifiersISSN: 1748-5908 • E-ISSN: 1748-5908
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/1748-5908-8-117
PMID24088228
PMCIDPMC3852739
OpenAlexW2111534125
LanguageEN
Citations received218
References cited46

BACKGROUND: Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. DISCUSSION: We examine the development of concepts of sustainability, and respond to two frequent assumptions -'voltage drop,' whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and 'program drift,' whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested 'adaptation phase' that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. SUMMARY: A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.

Business · Context (archaeology) · Economic growth · Economics · Geography · Health administration · Health care · Health services research · Management science · Process management · Psychological intervention · Public health · Sustainability · Sustainability organizations · Sustainability science · Community Health and Development · Health Policy Implementation Science · Health Systems, Economic Evaluations, Quality of Life · Medicine · Nursing · Health Policy

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Unique citing works218
Citations per year18,17
Citation span2014 - 2026 (13)
Citation velocitycurrent
Highly citedYes
Citation typesNeutral: 199
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