The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change

By David A. Chambers, Russell E. Glasgow, Kurt C. Stange. Implementation Science, 2013

1,402 citations recorded by the source corpus.

BackgroundDespite 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.DiscussionWe 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.SummaryA 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.

Subfields: Economics and Econometrics, General Health Professions

View Paper: https://www.semanticscholar.org/paper/3067bd878abd4eea9412032c47adb363b5b4ab4f

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Citations in the corpus

The effect of sport-based interventions on positive youth development: a systematic review and meta-analysis (2021, background): “…it has been reported that poor implementation is a major challenge in other physical activity interventions (e.g. McCrabb et al., 2019), leading to phenomena like program drift (i.e. a decrease in intervention e ﬀ ectiveness due to a deviation from manualized protocols; Chambers et al., 2013).”
Building State Capability: Evidence, Analysis, Action (2017, background): “” Instead, they contributed to what Chambers et al. (2013) call “dynamic sustainability” (involving ongoing improvement to systems and capabilities, not an end goal or resting point where one system or capability is simply maintained).”
Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies (2017, background): “Chambers et al’s dynamic sustainability framework recognizes that, in order to be sustained, an innovation must adapt to its unique local environment and evolve over time [115], echoing Hawe et al’s conceptualization of interventions as “events in [complex] systems” [116].”
An introduction to implementation science for the non-specialist (2015, background): “Moreover, it is important to know the degree to which an EBP, when utilized in general clinical practice, retains the active mechanisms while adapting to local site needs and priorities [61, 62].”
An Introduction to Effectiveness-Implementation Hybrid Designs (2019, background): “Indeed, many others have supported the notion of blurring across efficacy-effectiveness-implementation silos and/or bridging the practice-based/research-based divide (Brownson et al., 2013; Chambers et al., 2013; Chambers and Norton, 2016; Curran et al., 2012a; Glasgow et al., 2003; Green, 2006; Owe”
Implementation Research (2016, background): “The reasoning in favor of enacting innovations with fidelity is that once there is evidence that an innovation works, we must try to replicate the effects (Chambers et al., 2013).”
Enhancing the role of rural agricultural extension programs in poverty alleviation: A review (2021, background): “Its weaknesses had been its top-down nature, unbending, and non-sustainable (Chambers et al., 2013).”
When complexity science meets implementation science: a theoretical and empirical analysis of systems change (2018, background): “[41] suggest that a further consideration is the sustainability of an intervention.”
Implementation, context and complexity (2016, background): “Elasticity The extent to which contexts can be stretched or compressed in ways that make space for intervention components and allow them to fit [89].”