Holding Your QI Gains without the Pain

You are nearing the end of an 18-month long learning collaborative in which your team made a lot of changes at your facility. You have new processes and renewed energy—and it shows in the data you are collecting. Now, in just a few weeks, the learning collaborative will officially end, along with the dedicated resources it included. How does your team keep from backsliding on the progress it’s made?

The answer: A sustainability plan

Ensuring sustainability is not something you do at the end of a project; it should be built in from the start. If you are panicking and thinking, “But we haven’t done that!” Don’t worry. Your project most likely has a sustainability focus without you even realizing it.

The idea behind sustainability is to ensure an improved outcome from a specific change effort goes from being a temporary enhancement, which needs strong oversight, to the permanent way that work is done. In “Sustaining Improved Outcomes: A Toolkit,” Scott Thomas, PhD, and Deborah Zahn, MPH, describe 12 sustainability factors (see table below) as a menu to consider for building out a project’s sustainability plan.

“The secret is people are already doing sustainability work, but if you don’t have a framework of how to go about doing it, you aren’t focused on it,” says Thomas. “This just pulls out the factors and highlights them.”

Thomas and Zhan say the 12 factors are a menu, not a to-do list, because some areas may be more important or relevant to different people.

“People can look at the menu and say, ‘this is where we are weak, this is where we are strong, or we couldn’t do this even if we wanted,’” explains Thomas. “It helps to get people to start to work on places where they can strengthen.”

It is never too late to think about sustainability planning. When you do, Thomas and Zahn recommend considering two questions:

  1. How important is this factor to your particular improvement project?
  2. To what degree do we believe that you will be able to influence this factor?

“What the two questions do is help you sort through which of the factors to work on, with the idea being you are trying to strengthen sustainability, not figure out a magic formula for which this ends up being sustained,” says Thomas. “Knowing what is important and what will have an impact will save you from wasting time. It’s best to work on a sustainability factor you do have the ability to influence.”

12 Sustainability Factors (Definitions and Examples)

  1. Perceived Value – acknowledged value by those affected by the new ways of working and improved outcomes. Examples include project activities being considered potentially beneficial by clients, service providers, or community members.
  2. Monitoring and Feedback – monitoring is conducted on a regular basis and feedback is shared in easy to understand formats. Examples include information-gathering calls to monitor the project, and feedback provided to key staff using easy-to-understand formats (e.g., graphs).
  3. Leadership – the degree to which leaders (including decision-makers and champions) continue to be actively engaged beyond the implementation stage. Examples include ongoing attendance at meetings focused on the new ways of working and ongoing monitoring of outcomes.
  4. Staff – staff has the skills, confidence, and interest in continuing the new ways of working and improved outcomes. Examples include staff being able to use a new referral system capably or thinking that a new curriculum is more effective in achieving better outcomes.
  5. Shared Models – continued use of a shared model among those involved in the new ways of working. Examples include the Chronic Care Model, the 40 Developmental Assets, the 5As, or Plan-Do-Study-Act (PDSA).
  6. Organizational Infrastructure – degree to which organizational operations support the new ways of working and improved outcomes. Examples include rewriting job descriptions to support the project activities and channeling resources to project activities through the organization’s business plan.
  7. Organizational Fit – degree to which the new ways of working and improved outcomes match the organization’s overall goal and operations. Examples include project activities becoming part of the organization’s strategic plan.
  8. Community Fit – degree to which the new ways of working and improved outcomes match community interests, needs, and abilities. Examples include an expressed desire for new or improved services and outcomes.
  9. Partners – involvement of partners who actively support new ways of working and improved outcomes. Examples include partners who continue to contribute staff or resources after the implementation phase.
  10. Spread – expansion of new ways of working and improved outcomes to additional locations. Examples include expanding activities planned for one community agency or department to new agencies or departments.
  11. Funding – funding beyond original project period. Examples include extensions of original grant funding or funding to expand project activities to additional populations or communities.
  12. Government Policies – degree to which new ways of working and improved outcomes are supported by government policies. Examples include reimbursement for a new service or incorporating outcome measures into surveillance systems.

(Source: Sustaining Improved Outcomes: A Toolkit)

View and download a variety of free sustainability planning tools at