EDITORIAL COMMENT

Editorial Comment

In so many of the publications on healthcare research, we see innovative programmes being tried and tested, new treatment methods being introduced or compared to existing ones, all aimed at improving the health and well-being of diverse populations within health care facilities or in communities. Some very encouraging and successful strides are being made in the health care environment, and once improvements in the quality of care are reached, a whole new challenge arises, namely sustaining the healthcare quality that was achieved¹.

Ronald D. Snee², a fellow with the American Society for Quality, states that many organisations focus on sustaining improvement only after it has been achieved, but that the time to focus on sustaining improvement gains should precede the launching of an initiative. It shouldn't become an afterthought.

Sustainability is defined by Scheirer and Dearing³ as "the capacity to maintain programme services at a level that will provide ongoing prevention and treatment for a health problem after termination of major financial, managerial and technical support"^3:2060.

Funders and researchers of innovative programmes need to know whether or not their investments have led to longer-term beneficial outcomes. The only way to meet this need is through thorough sustainability research. Another reason for sustainability research involves ethical concerns and accountability. Are community stakeholders or partners left with the responsibility to sustain a service or programme when researchers withdraw or when funding runs out³?

Programme planning, implementation and sustainability should be parallel processes; they should advocate for sustainability to be integrated into the design of interventions and planned for in advance⁴.

Through a comprehensive review of literature and concept mapping processes, Schell et al.⁵ developed a nine-domain conceptual framework for programme sustainability. The nine domains are: political support, funding stability, partnerships, organisational capacity, programme evaluation, programme adaptation, communication, public health impacts and strategic planning⁵.

The purpose of this framework is to help create a shared understanding of sustainability across a variety of public health decision programme stakeholders such as decision-makers, practitioners, funders, researchers and evaluators⁵.

Would a review or analysis of evidenced-based research in the field of occupational therapy show that the majority of programmes do continue effectively and successfully after withdrawal occurs? As almost all interventions that need to be sustained occur within an organisational or community context, proper programme monitoring and evaluation practices and methods should be embedded in the initial planning and later execution of the research. Such strategies will enable us to provide a more longitudinal evaluation of the sustainability of the programmes and changes which so many of our research endeavours are aimed at.

By demonstrating that we take our sustainability efforts seriously, we also show that the care that we provide extends to the communities that we serve.

BLANCHE PRETORIUS

EDITOR IN CHIEF

REFERENCES

1. Van Etten C. How to sustain Healthcare Quality improvement in three critical steps. https://www.healthcatalyst.com/insights/5-Deming-Principles-For-Healthcare-Process-Improvement        [ Links ]

2. Snee R.D. If you're not keeping score, it's just practice. https://asq.org/quality-progress/articles/statistics-roundtable-if-youre-not-keeping-score-its-just-practice?id=69c34a1b1e8d45088264ffceb9f4a43d        [ Links ]

3. Scheirer MA, & Dearing J.W. An agenda for research on the Sustainability of Public Health Programs. American Journal of Public Health (AJPH). November 2011. https://doi.org/10.2105/AJPH.2011.300193        [ Links ]

4. Moore, J.E., Mascarenhas, A., Bain, J. et al. Developing a comprehensive definition of sustainability. Implementation Sci. 2017; 12: 110. 110. https://doi.org/10.1186/s13012-017-0637-1        [ Links ]

5. Schell S.F., Luke D.A., Schooley M.W., Elliott M.B., Herbers S.H., Meuller N.B., Bunger A.C. Public health program capacity for sustainability: a new Framework. Implement Sci. 2013; 8: 1. https://doi.org/10.1186/s12961-018-0405-y        [ Links ]