Building for Sustainability

Introduction

Improving patient care and experience is a fundamental aim for all healthcare systems but can be frustrating, demotivating, and a waste of valuable resources if improvement is short-lived. Unfortunately, only 30% of projects achieve and sustain their goal. Lack of resources are often assumed to be the cause of failure to sustain, but in 70% cases it is because of employee resistance or lack of management support.

Right from the start, sustainability (i.e., “ensuring gains are maintained beyond the life of a project” ) needs be considered. Do not “dive straight in.” Spend time planning, understanding the current system, considering who needs to be involved, and establishing measures to facilitate ongoing quality control and monitor improvement. With increasingly complex multidisciplinary pathways in perioperative medicine, these factors are particularly important.

Several models have been described to support achieving sustainability; all have similar components. One of these, the National Health Service UK (NHS) change model, was created by NHS staff, who shared their experiences to produce an 8-point model ( Fig. 18.1 ). The factors included are: (1) shared purpose, (2) improvement methodology, (3) project management, (4) measurement, (5) system drivers, (6) mobilize and engage, (7) leadership, and (8) spread and adoption.

Shared Purpose

Describe and share the vision, linking to each other's values, to feel a connection and desire for it to succeed. Finding this “passion” for each individual requires time and active listening.

How can you demonstrate the existing problem and inspire feeling in others? Do you have patient stories to tell, or could you use a visual display?

Identify all staff who may be impacted or involved in the change or who have influence on it. There are stakeholder tools, which can help ensure no one is overlooked.

Set up a multidisciplinary group of all involved, including physicians, nurses, front-line workers, and managers and administrators. This facilitates input and communication from the beginning.