Designing for sustainability: an 8-year mixed methods evaluation of a timely drug administration initiative

Sustaining improvements from large-scale quality initiatives in hospital settings remains a persistent challenge. When such improvements fade, patient safety risks may re-emerge. Despite their importance, long-term post-implementation evaluations of large-scale hospital initiatives are scarce.

This study aimed to identify long-term insights into the sustainability of a large-scale hospital initiative designed to improve timely drug administration.

A mixed methods case study was conducted on an Australian hospital-wide initiative implemented in 2014-2015. Quantitative data included rates of unintentional drug omissions before, during, and after the initiative. Qualitative data were collected through 13 individual semi-structured interviews with stakeholders, including implementation team members, hospital staff, and managers. Thematic analysis was conducted inductively and then categorized deductively using an evidence-based sustainability framework. Mixed methods data were integrated for interpretation.

Drug omission rates showed potential medium-term improvement; however, long-term outcomes were inconclusive due to changes in national audit methodology. The initiative included multifaceted interventions co-produced with staff, focusing on system change (e.g., prescription ordering) and staff behavior change (e.g., education). Eight years after the initiative's completion, system-based interventions remained embedded with sustained benefits; however, behavioral interventions did not continue after the initiative. Interview participants identified key enablers and barriers to sustaining change, offering valuable lessons for future hospital initiatives.

This study provides long-term insights into designing and sustaining large-scale changes in hospital settings. The findings highlight the importance of system-level interventions, staff engagement, and ongoing leadership support. The study offers actionable strategies for health care managers and professionals to enhance the sustainability of improvement efforts.

http://links.lww.com/IJEBH/A549.