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Institute for Innovation

and Improvement

Sustainability
Model and Guide
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2 Sustainability
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NHS Sustainability Model

Authors
Lynne Maher1 Professor David Gustafson2 Alyson Evans2

1 - NHS Institute for Innovation and Improvement, Coventry House, University of Warwick, Coventry CV4 7AL
2 - University of Wisconsin, Rm 1119 WARF Building, 610 Walnut Street, University of Wisconsin Madison 53705

Institute for Innovation

and Improvement

Sustainability 3
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Sustainability Contents
Introduction

How to use the NHS Sustainability Model

The Sustainability Model

Process
Staff
Organisation

The Sustainability Model master score system

The score system bar chart and portal diagram

The NHS Sustainability Guide CD

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Monitoring progress

Training and involvement

Behaviours

Adaptability
Staff
Senior leaders

Credibility of benefits
Process

Clinical leaders
Benefits beyond helping patients
Organisation

Infrastructure

Fit with goals and culture

Sustainability 5
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Introduction
Quality improvement often takes longer than expected to take hold
and longer still to become widely and firmly established within an organisation
Ham et al, 2002

The most successful organisations are those that can implement and sustain effective
improvement initiatives leading to increased quality and patient experience at lower
cost. The Sustainability Model and Guide has been developed to support health
care leaders to do just that.

Health services around the world need to consistently deliver high quality care at
lower cost and against rising expectations and demand. To achieve this we need to
continually improve our existing health systems and processes. Any change requires
a significant investment of time, financial resource and leadership effort. There is
evidence that up to 70% of all organisational change fails to survive and that is
just not acceptable when undertaking health care improvement1.

The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.

The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.

“Sustainability means Sustainability can be described as ‘when new ways of working and improved
outcomes become the norm’. A more detailed description, which includes
the notion of ‘steady state’, is as follows:
holding the gains and ‘Not only have the process and outcome changed, but the thinking and attitudes
behind them are fundamentally altered and the systems surrounding them are
transformed as well. In other words the change has become an integrated or
evolving as required - mainstream way of working rather than something ‘added on’. As a result, when you
look at the process or outcome one year from now or longer, you can see that at a
minimum it has not reverted to the old way of working, or old level of performance.
Further, it has been able to withstand challenge and variation; it has evolved alongside
definitely not going back.” other changes and perhaps has continued to improve over time. Sustainability means
holding the gains and evolving as required - definitely not going back’.
(NHS Institute for Innovation and Improvement 2005)

1
Daft and Noe, 2000. Beer and Nohria, 2001

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Development of the Sustainability Model and Guide

The Sustainability Model consists of 10 factors relating to process, staff and The structure of the Guide mirrors the 10 factors identified within the Sustainability
organisational issues, that play a very important role in sustaining change Model. In doing so, it creates a comprehensive package consisting of a diagnostic
in healthcare. The Model has been developed with and for the NHS using a model and guidance for sustainability. Information within the Guide was gathered
co-production approach. Contributors include: front line teams, improvement from a variety of sources. These include the available literature on change and
experts, senior administrative and clinical leaders from within the NHS and people sustainability, discussions with experts within and outside of healthcare and small
with specific expertise in the subject area from academia and other industries. research studies commissioned to explore specific learning from ongoing
The development of the Model is based on the premise that the changes individuals improvement programmes within the healthcare settings.
and teams wish to make fulfil the fundamental principle of improving the patient
experience of health services. Another important impact that can be gained by We have provided what we hope will be helpful, practical advice relating to each of
using the Model is the effective achievement of change which creates a platform the 10 sustainability factors. We recognise that this is not exhaustive and that other
for continual improvement. By holding the gains, resources - including financial sources of useful information do exist. If you find something that works really well
and most importantly human resources - are effectively employed. They are for you and is not in the Guide, we would be happy to hear about it. Contact us at
not wasted because processes that were improved have reverted to the old [email protected]
way or old level of performance.

The Sustainability Guide was developed as a direct result of requests from

NHS staff who were using the Model.

‘The problem is confirmed but I am not sure what to do about it’

Project director

‘I now have an indication of where I should focus some effort, but where do I get
further advice?’
Service improvement manager

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How to use the Sustainability Model

The goal for creating the Sustainability Model was to develop an easy-to-use tool to The Sustainability Model can be used by individuals or teams. For example, project
help teams: leaders may wish to undertake a sustainability assessment based on their individual
• plan for sustainability of improvement efforts thoughts. This will be useful in terms of providing an overview of the likelihood of
• recognise and understand key barriers for sustainability, relating to their specific sustainability. However, we have found that a much richer picture can be gained if
local context more members of the team, or those involved in the improvement initiative, complete
• self-assess against a number of key criteria for sustaining change the diagnostic Model. In our experience, we have found that while one person might
• identify strengths in sustaining improvement score a sustainability factor highly, another has a completely different perspective.
• monitor progress over time. It is these different perspectives that are important to understand. This is particularly
significant if the improvement initiative spans a whole system, for example a hospital,
The Model has been designed for use at the level of a specific planned or ongoing doctor’s surgery and nursing home. In addition to providing an overall ‘sustainability
improvement initiative or project. For example: within a doctor’s surgery to create score’, the act of completing the Model can lead to useful discussions about your
advanced access for patients; within a health community to develop a systematic improvement initiative.
approach to care for patients with diabetes; within critical care environments to
create safer and more effective care through the development of care bundles; or We believe that the best way to use the Sustainability Model is at several different
within a healthcare organisation to redesign and extend roles. These are just a few points in time:
examples to guide you. • at the first planning stage, just as you are setting up your improvement project -
this will enable you to identify and improve areas that require strengthening right
The Model has not been designed to assess whether a department, whole from the start
organisation or health community is likely to sustain change in general. Its use • around the time of initial pilot testing so that you can go into the full
needs to be linked to a specific improvement initiative. implementation phase with confidence
• a few weeks after the improvement has been implemented to ensure an optimal
position for sustainability and continual improvement.

Don’t feel restricted by this though; you can use the Model at any time during your
improvement initiative.

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What to do now
Start from the beginning - it’s like baking a cake 1 Read through each of the 10 factor descriptions.
2 For each factor select the level of each factor that best describes your local project.
People typically think that any consideration or action that might be needed to Remember these factors may not exactly describe your situation.
ensure sustainability of their improvement initiative can wait until the end of the 3 Place a tick next to the ‘factor level’ you have selected.
project. In our experience, if you leave it to the end it will be too late to make any 4 When you have worked through all of the factors and identified a factor level for
changes that are needed to maximise the potential of sustainability. each, go to the ‘Master Score System’ on page 22 where you will find the
numerical values for each factor level. Calculate the scores and enter these onto
Think about it in terms of baking a cake; if all the ingredients are measured out the Master Score System on page 23.
correctly; if the mixing is carried out in the right way, if the cake tin is prepared 5 Add up all of the scores to arrive at an overall sustainability score.
correctly, if the oven is at the right temperature and we bake the cake for the (Preliminary evidence suggests a score of 55 or higher offers reason for optimism.
prescribed amount of time, it is highly likely that the cake will be just as we expected- Scores lower than this suggests that you need to take some action to
delicious. But if the ingredients, measures, mixing and so on are not just in the right increase the likelihood that your improvement initiative will be sustainable.)
proportion, or if the oven temperature is not exactly right, the cake will not turn out 6 Identify the factors with greatest potential for improvement by plotting the scores.
as we expected or desired. At this stage it is often too late to rectify any problems. You can either use the bar chart or portal diagram (pages 24 and 25) to do this;
The ten factors that we describe in this model and guide as being important for choose which method you prefer.
sustainability could represent the elements required to create the best cake that we 7 We advise that you start by concentrating on the two or three factors with
can. It is really important to ensure that you have things in place from the the greatest potential for improvement. Go to the corresponding sections
beginning in order to achieve the best improvement outcome that you can of the NHS Sustainability Guide, on the CD attached, for some useful
and sustainability of that improvement. information on how you might improve the score for each factor. Feel
free to browse through any of the other sections at any time.

We are continuing to assess the use and impact of the Sustainability Model and
Guide. We would be pleased to receive any thoughts or comments that you have
for their improvement. Please contact us with any advice or comments at:
[email protected]

Sustainability 9
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Monitoring progress

Adaptability

Credibility of benefits
Process

Benefits beyond helping patients

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Process

What can you find in the Sustainability Guide CD?

Benefits beyond helping patients
• Use role/process mapping to illustrate areas of duplication, waste or inefficiency. Get staff to create their own role map that can be updated as roles and processes change
• Assess ‘what is going well’ and ‘even better if’ from the perspective of staff and prioritise actions using dot voting
• Think of ways to release more time for staff and engage a wider community in the improvement work
• Support staff by making a plan to manage the transition from old to new ways of working.

Credibility of the evidence

• Find out how you can effectively identify the benefits of the improvement that you are making
• ‘Walk in their shoes’ or use experience based design techniques to understand change from different perspectives
• See tips on gathering and communicating the evidence of the benefits of the changed process
• Use seven questions to help create your improvement story.

Adaptability of improved process

• Find out how you can adopt and adapt ideas from others
• Read a short case study about adapting an improvement idea
• Think about aspects of organisational change that might disrupt the progress of your improvement project
• Prepare a succession plan for the future of the process or service.

Effectiveness of the system to monitor progress

• Use measurement and communication to help staff look ahead to continual improvement
• Find frameworks to help identify what are the most effective measures to use
• See examples of graphs, bubbles, pictures and quotes
• Learn about segmenting your messages for more effective communication.
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Choose the factor level that comes closest to your situation and tick the box to the left of it
Process
Factor description Identify () Factor level

Benefits beyond helping patients 15.0 We can demonstrate that the change has a wide range of benefits beyond helping

• In addition to helping patients, are there other benefits? a 6.7

patients, for example by reducing waste, creating efficiency or making people’s
jobs easier.
• For example, does the change reduce waste or avoid duplication?
• Will it make things run more smoothly? 5.5 We can demonstrate that the change has some benefits beyond helping patients such
• Will staff notice a difference in their daily working lives? b 0.0
as reducing waste and making jobs easier, but not a wide range.

We can demonstrate that the change has one or two benefits beyond helping patients.
c eg 

The benefits that we have identified are only directly related to helping patients.
d We have not identified any other benefits that this initiative could bring.

Credibility of the benefits 15.0 Benefits of the change are widely communicated, immediately obvious, supported

• Are benefits to patients, staff and the organisation visible?

a 6.7
by evidence and believed by stakeholders. Staff are able to fully describe a wide range
of intended benefits for this initiative.
• Do staff believe in the benefits?
• Can all staff clearly describe the a full range of benefits? 5.5 Benefits of the change are not widely communicated or immediately obvious even
• Is there evidence that this type of change has been
achieved elsewhere?
b 0.0
though they are supported by evidence and believed by stakeholders.

Benefits of the change are not widely communicated or immediately obvious even
c though they are supported by evidence. They are not widely believed by stakeholders.

Benefits of the change are not widely communicated, they are not immediately
d obvious, nor are they supported by evidence or believed by stakeholders.

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Choose the factor level that comes closest to your situation and tick the box to the left of it
Process
Factor description Identify () Factor level

Adaptability of improved process 15.0 The improved process can adapt to link in with and even support other organisational

• Can the new process overcome internal pressures,

a 6.7
changes. It would not be disrupted if specific individuals or groups left the project.
Its focus will continue to meet the improvement needs of our organisation.
or will this disrupt the change?
• Does the change continue to meet ongoing 5.5 The improved process can be adapted to support wider organisational change but it
needs effectively?
• Does the change rely on a specific individual or group
b 0.0
would be disrupted if specific individuals or groups left the project. Elements of this
work will continue to meet our organisations improvement needs.
of people, technology, finance etc, to keep it going?
• Can it keep going when these are removed? It would be difficult to adapt the new process to other organisational changes.
c It would cause disruption if specific individuals or groups left the project.

d The new process could not adapt if there was any other organisational change
happening and it would be disrupted if specific individuals or groups left.

Effectiveness of the system to monitor progress 15.0 There is a system in place to provide evidence of impact, including benefits analysis,

• Does the change require special monitoring systems to a 6.7

monitor progress and communicate the results. This is set up to continue beyond the
formal life of the project.
identify and continually measure improvement?
• Is there a feedback system to reinforce benefits and 5.5 There is a system in place to provide evidence of impact, including benefits analysis,
progress and initiate new or further action?
• Are mechanisms in place to continue to monitor progress
b 0.0
monitor progress and communicate the results. This is not set up to continue beyond
the formal life of the project.
beyond the formal life of the project?
• Are the results of the change communicated to There is a system in place to provide evidence of impact and monitor progress. However
patients, staff, the organisation and the wider
healthcare community?
c none of this information is communicated more widely than the core project team. The
measurement system is not set up to continue beyond the formal life of the project.

There is only a very patchy system to monitor progress and this will end at the same
d time as the project. There is no system to communicate the results.

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Training and involvement

Behaviours

Senior leaders
Staff

Clinical leaders

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Staff

What can you find in the Sustainability Guide CD?

Staff involvement and training to sustain the process
• Learn how to recognise the characteristics displayed when staff feel lack of involvement
• Read tips on creating a culture of involvement
• Use the ‘Six Thinking Hats’ for maximum involvement during decision making
• Read case studies from other organisations.

Staff behaviours toward sustaining the change

• Find out about key points that affect staff involvement
• Understand a range of possible concerns from staff
• Explore a range of steps that you can take to reduce those concerns
• See links to other sources of support.

Senior leadership engagement

• Enable leaders to be involved and updated
• Think about the most appropriate communication mechanisms for leaders
• Formulate a plan to raise awareness of the improvement work with senior leaders
• Identify specific roles for leadership involvement.

Clinical leadership engagement

• Understand the clinician’s perspective
• Use the ‘Clinical engagement continuum’ as a tool
• Identify factors to support clinical engagement at a local level
• Find out how to enlist support.
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Choose the factor level that comes closest to your situation and tick the box to the left of it
Staff
Factor description Identify () Factor level

Staff involvement and training to sustain 15.0 Staff have been involved from the beginning of the change process. They have
the process a 6.7
helped to identify any skill gaps and have been able to access training and
development so that they are confident and competent in the new way of working.
• Do staff play a part in innovation, design and
implementation of the change? 5.5 Staff have been involved from the beginning of the change process and have helped
• Have they used their ideas to inform the change process b 0.0
to identify skills gaps but they have not had training or development in the new way
of working.
from the beginning?
• Is there a training and development infrastructure to
Staff have not been involved from the beginning of the change but they have received
identify gaps in skills and knowledge and are staff
educated and trained to take the change forward? c eg  training in the new way of working.

Staff have not been involved from the beginning of the change process and have not
d had training or development in the new way of working.

Staff behaviours toward sustaining the change 15.0 Staff are able to share their ideas regularly and some of them have been taken on

• Are staff encouraged and able to express their ideas a 6.7

board during the project. They believe that the change is a better way of doing things
and have been empowered to run small scale test cycles (Plan, Do, Study, Act).
regularly throughout the change process and is their
input taken on board? 5.5 Staff are able to share their ideas regularly and some of them have been taken on
• Do staff think that the change is a better way of doing
things that they want to preserve for the future?
b 0.0
board during the project. They believe that the change is a better way of doing things.
Staff do not feel empowered to run small scale test cycles (Plan, Do, Study, Act).
• Are staff trained and empowered to run small-scale tests
(PDSA) based on their ideas, to see if additional Staff are able to share their ideas regularly but none seem to have been taken on board
improvements should be recommended? c during the project. They don’t think that the change will be a better way of doing
things. They don’t feel empowered to run small scale test cycles (Plan, Do, Study, Act).

Staff do not feel they have been able to share their ideas. They do not believe that the
d change is a better way of doing things and they have not been empowered to run
small scale test cycles (Plan, Do, Study, Act).

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Choose the factor level that comes closest to your situation and tick the box to the left of it
Staff
Factor description Identify () Factor level

Organisational leaders are highly involved and visible in their support of the
Senior leadership engagement and support 15.0
• Are the senior leaders trusted, influential, respected and
a 6.7
change process. They use their influence to communicate the impact of the work
and to break down any barriers. Staff regularly share information with and actively
seek advice from leaders.
believable?
Organisational leaders are highly involved and visible in their support of the change
• Are they involved in the initiative, do they understand it 5.5
and do they promote it? b eg  process. They use their influence to communicate the impact of the work and to
break down any barriers. Staff typically don’t share information with, or seek advice
• Are they respected by their peers and can they influence 0.0 from leaders.
others to get on board?
Organisational leaders are somewhat involved but not highly visible in their support
• Are they taking personal responsibility to help break
down barriers and are they giving time to help ensure c of the change process. They use their influence to communicate the impact of the
work but cannot be relied upon to break down any barriers if things get difficult.
the change is successful? Staff typically don’t share information with, or seek advice from leaders.
Organisational leaders are not involved or visible in their support of the change
d process. They have not used their influence to communicate the impact of the
work or to break down any barriers. Staff typically don’t share information with
or seek advice from leaders.

Clinical leaders are highly involved and visible in their support of the change
Clinical leadership engagement and support 15.0
• Are the clinical leaders trusted, influential, respected a 6.7
process. They use their influence to communicate the impact of the work and to
break down any barriers. Staff regularly share information with and actively seek
advice from clinical leaders.
and believable?
Clinical leaders are highly involved and visible in their support of the change process.
• Are they involved in the initiative, do they understand it 5.5
and do they promote it?
• Are they respected by their peers and can they influence
b 0.0
They use their influence to communicate the impact of the work and to break down
any barriers. Staff typically don’t share information with, or seek advice from
clinical leaders.
others to get on board?
Clinical leaders are somewhat involved but not highly visible in their support of the
• Are they taking personal responsibility to help break
down barriers and are they giving time to help ensure c change process. They use their influence to communicate the impact of the work but
cannot be relied upon to break down any barriers if things get difficult. Staff typically
the change is successful? don’t share information with, or seek advice from clinical leaders.
Clinical leaders are not involved or visible in their support of the change process.
d They have not used their influence to communicate the impact of the work or to
break down any barriers. Staff typically don’t share information with, or seek advice
from clinical leaders.

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Organisation

Infrastructure

Fit with goals and culture

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Organisation

What can you find in the Sustainability Guide CD?

Fit with organisational strategic aims and culture
• How to embed improvement into the organisations mainstream business
• Use a framework to demonstrate the relationship between the improvement and organisational goals and vision
• Read the case study illustrating non-alignment of improvement and organisational goals.

Infrastructure for sustainability

• Align roles and job descriptions with the new process.
• Use a table to help develop new procedures reflecting the improvement
• Use a simple cost benefit analysis framework to consider ongoing resource needs for staff and equipment
• Read about four important questions to ask when developing your communication plan.
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Choose the factor level that comes closest to your situation and tick the box to the left of it
Organisation
Factor description Identify () Factor level

Fit with the organisation’s strategic aims 15.0 The goals of the change are clear and have been shared widely. They are consistent
and culture a 6.7
with and support the organisation’s strategic aims for improvement. The organisation
has demonstrated successful sustainability of improvements before and has a ‘can
• Are the goals of the change clear and shared? do’ culture.
• Are they clearly contributing to the overall organisational 5.5 The goals of the change are clear and have been shared widely. They are consistent
strategic aims?
• Is improvement important to the organisation and
b 0.0
with and support the organisation’s strategic aims for improvement. The organisation
has not demonstrated success in sustaining previous improvements and does not have
a ‘can do’ culture.
its leadership?
The goals of the change are clear and have been shared widely. They have not
• Has the organisation successfully sustained improvement
in the past? c eg  been linked with the organisation’s strategy so we don’t know if they support any
organisational aims for improvement. The organisation has not demonstrated success
in sustaining previous improvements and does not have a ‘can do’ culture.
The goals of the change are not really clear and they have not been shared widely. They

d have not been linked with the organisation’s strategy so we don’t know if they support
any organisational aims for improvement. The organisation has not demonstrated
success in sustaining previous improvements and does not have a ‘can do’ culture.

Infrastructure 15.0 Staff are confident and trained in the new way of working. Job descriptions,

• Are the staff fully trained and competent in the new

a 6.7
policies and procedures reflect the new process and communication systems
are in place. Facilities and equipment are all appropriate to sustain the new process.
way of working?
• Are there enough facilities and equipment to support 5.5 Staff are confident and trained in the new way of working. However, job descriptions,
the new process?
• Are new requirements built into job descriptions?
b 0.0
policies and procedures do not reflect the new process. Some communication systems
are in place. Facilities and equipment are all appropriate to sustain the new process.
• Are there policies and procedures supporting the
Staff are confident and trained in the new way of working. However, job
new way of working?
• Is there a communication system in place? c descriptions, policies and procedures do not reflect the new process and there
are no communication systems to adequately support the new process. Facilities
and equipment are not appropriate to sustain the new process.
Staff have not been trained in the new process and are not confident in the new way

d of working. Job descriptions, policies and procedures do not reflect the new process
and there are no communication systems to adequately support the new process.
Facilities and equipment are not appropriate to sustain the new process.

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Sustainability Master Score System

Sustainability 21
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Enter your scores

Process

Benefits a a a a
8.5 Credibility of 9.1 Adaptability 7.0 Effectiveness 6.5
beyond b the evidence b of improved b of the b
helping
Write your 4.7 Write your 6.3 process
Write your 3.4 system to
Write your 3.3
score in the score in the score in the score in the
c c c c
patients circle 4.0 circle 3.1 circle 2.4 monitor circle 2.4
d 0.0 d 0.0 d 0.0 progress d 0.0

Staff

Staff a a a a
11.4 Staff 11.0 Senior 15.0 Clinical 15.0
involvement b behaviours b leadership b leadership b
and training
Write your 6.3 toward
Write your 5.1 engagement
Write your 6.2 engagement
Write your 6.7
score in the score in the score in the score in the
c c c c
to sustain circle 4.9 sustaining circle 5.1 circle 5.7 circle 5.5
the process d 0.0 the change d 0.0 d 0.0 d 0.0

Organisation
Fit with the a a
7.0 Infrastructure 9.5
organisation’s b for b
strategic
Write your 3.5 sustainability
Write your 4.4
score in the score in the
c c
aims and circle 3.3 circle 3.3
culture d 0.0 d 0.0

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Calculate your total scores

Process total score

+
Staff total score
+
Organisation total score
=
Date:
Sustainability total score

To calculate your score, use the master score system on the opposite page. Add the Process,
Staff and Organisation scores together and place in the Sustainability total score box above.
Now go to the bar chart and portal diagram provided at the back of this document and
plot your scores.

Interpreting your scores?

We do advocate that you use the Sustainability Model at the beginning of your improvement initiative
as it can provide you with a vaulable understanding of where you can strengthen your work in order
to maximise the potential for sustainability. You need to note that at this stage it is normal to have
low scores in one or two of the factors. For example; infrastructure often has a low score initially as
the tasks of fuly training staff in the new process and revieiwing role descriptions are usually
undertaken later in the project. With each score teams should assess what the score means to them in
their particular context. Use the scores as a reminder of important tasks even if they need to be
undertaken at a later stage. (See the example on page 24).

Sustainability 23
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Portal diagram and bar chart

Use either the portal diagram or the bar chart to plot your scores and identify which
factors require most attention. You can use both if you prefer.

Within the example diagrams here, we have inserted example scores as an illustration. Now plot the scores for your project on either the portal diagram or the bar chart and look
You will note that ‘Adaptability of the improved process’ has the lowest numerical score to see which are the two or three factors with the greatest potential for improvement.
of 3.4. However, this is not the factor where the biggest improvement gain can be made.
Now look at the factor ‘Clinical leadership engagement’. You will see that the overall
potential for improvement is much bigger therefore this is the factor to focus on.

Interpreting your scores

Look at the example scores in the bar chart or portal diagrams. What do they tell Portal diagram Benefits
16
you? Use the ideas here to help you interpret your scores.
Credibility of
• Clinical leadership Infrastructure the evidence
A large amount of work is needed to help clinicians be more involved. 12
Some have been involved in the early stages but this is too little.
None are actively involved in the work or promote the initiative.
One meeting has been arranged recently, but we need to build on this.
8
• Involvement and training
Some staff have not been involved from the beginning of the initiative and Fit with
we need to catch up with them. There does seem to be some confusion goals and Adaptability
about what we are really trying to do and we also need to see what their culture 4
ideas are. We also need to have a sharper focus on training staff to manage
the new way of working as it is implemented and established. We will link
this in with the ‘Infrastructure’ factor.
0
• Infrastructure
We have not thought about changing any policies or procedures yet.
Communication systems are limited at this early stage of the work, but
we do need to strengthen this factor urgently. One of the first things
Clinical
to do is set up some information in the work area so that staff can
leaders Monitoring
see progress.
progress

The dark blue points represent the maximum possible numerical score
achievable for each of the 10 factors

The grey points represent the example score Senior

leaders Involvement
The gap between the dark blue and grey points shows the improvement and training
potential for each of the 10 factors - ie, the bigger the gap, the greater
Example score Behaviours
the potential for improvement.
Maximum score

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Score system bar chart

0 2 4 6 8 10 12 14 16
Example score
Benefits beyond helping patients
Your score

Example score
Credibility of the evidence
Your score

Example score
Adaptability of improved process
Your score

Example score
Effectiveness of the system to monitor progress
Your score

Example score
Staff involvement and training to sustain the process
Your score

Example score
Staff behaviours toward sustaining the change
Your score

Example score
Senior leadership engagement
Your score

Example score
Clinical leadership engagement
Your score

Example score
Fit with the organisation’s strategic aims and culture
Your score

Example score Sample score

Infrastructure for sustainability
Your score
Maximum score

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Why should I use the Sustainability Guide?

10 top reasons to look at this CD…

If you’ve already worked through the Sustainability Model, you’ll now know where your The Guide will help you ensure your sustainability activities are:
priority areas are for sustaining your improvement - but what next? You might be 1 Focused: you don’t need to read the whole Guide - just go straight to the parts
wondering what you’ll gain by going into the Sustainability Guide: will it be worth where your scores were lowest and where you can have most impact
the effort; will you be able to find what you want; and even then, will it tell you 2 Practical: the Guide is packed with practical ideas and tools for you to try
anything new? 3 Visual: you’ll learn about the best process mapping techniques to help you and
your staff visualise how improvements are changing processes and roles
In putting this Model and Guide together, we have been constantly aware of the 4 Inclusive: you’ll find out how to get your staff involved, for instance ‘dot voting’
huge pressures on your time as improvement leaders; clinicians; service managers and to pinpoint the really important issues
frontline professionals. You’ll want to know that any time you spend going through 5 Doable: bringing benefits to life will become easier with simple, achievable
the Guide will be as useful and practical as arriving at your sustainability score techniques like creating a ‘data wall’ and letting service users do the talking
through the Model. 6 Balanced: if you’ve never used the ‘Six thinking hats’ method (De Bono 1999)
find out how it can help you consider sustainability from every angle
Here’s 10 good reasons to use this Guide and get some new ideas and practical 7 Tailored: find out how to present your data and communications in a way that
measures for tackling the areas most relevant to you. your different audiences will welcome and understand
8 Forward thinking: plan for long-term sustainability by making sure your
improvement goals fit with the organisation’s wider strategic aims and visions
9 Holistic: explore better ways to ensure your change is embedded in your
organisation’s wider systems - through detailed job descriptions, clear policies
and communication channels that work
10 Real: read real life case studies from frontline teams who are successfully
sustaining their improvements.

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Sustainability Guide CD
How to use this CD
This CD has one downloadable PDF file that contains all of the Sustainability Guide
information. The Guide is intended to be used with the Sustainability Model.
Once you have identified the factors with the greatest potential for improvement,
using the Sustainability Model, go to the appropriate section(s) on this PDF where
you will find valuable guidance and advice.

The PDF files on this CD are:

ST_GUIDE_FEB2010
ST_WHYTHE_CD - Top ten reasons to look at this CD.

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‘The challenge is not starting,

but continuing after the initial enthusiasm has gone’
Ovretveit (2003) Making temporary quality improvement continuous:
A review of the research relevant to the sustainability of quality improvement in healthcare

For further information visit

www.institute.nhs.uk/sustainability

ISBN: 978-1-907045-36-3

© 2010 NHS Institute for Innovation and Improvement