When undertaking any healthcare associated infection (HCAI) reduction programme, it is important to remember to plan before, during and after any project to maintain the sustainability of the project. It is crucial that any improvements made are maintained and are continuously improved on over time.
Health service research has found that 33% of improvement efforts are not sustained (Ham 2002). This means that the time, money and effort invested in one of three of your improvement projects might have been better used elsewhere and that in one in three cases, your patients may not reap the benefits.
Sustainable reductions in HCAIs require the proactive involvement of every member of staff across all healthcare settings. It requires a culture of ‘zero tolerance’ of avoidable infections that is embedded across the organisation from board to ward.
How can providers and commissioners ensure sustainability? Firstly, you need to plan for sustainability as early on in any project as possible. Think clearly about the task ahead. Your work to provide safe, clean care has not finished just because you have hit your milestones. What are you going to do to maintain the gains?
The NHS Institute for Improvement and Innovation Sustainability Model provides a useful framework which can help you:
- Assess your improvement initiative against a number of key criterion for sustaining change
- Recognise and understand key barriers to sustainability relating to the specific local context
- Identify your current strengths in sustaining improvement
- Monitor progress over time
‘The NHS Institute for Improvement and Innovation Sustainability Model is a diagnostic scoring model designed to be used by each member of the core project team. The information collected provides the whole team with a good understanding of areas that need improving in order to maximise the potential of sustainability within the project. An accompanying Sustainability Guide provides a range of practical ideas about how to actually make those improvements’.
Dr. Lynne Maher, Interim Director for Innovation, NHS Institute for Innovation and Improvement.
HCAI Sustainability Assessment tool
The HCAI Sustainability Assessment tool has been adapted from the NHS Institute for Innovation and Improvement Sustainability Model. It is supported by the NHS Institute for Innovation and Improvement, and aims to reflect the HCAI agenda and help organisations in the delivery of clean, safe care.
The HCAI focussed sustainability tools include:
1. HCAI Sustainability Assessment Tool – Question Sheet
The HCAI Sustainability Assessment Tool is for completion by staff within an organisation planning an HCAI improvement project. Ideally, different members of staff would complete it at the start of the project, across the organisation, from Board to Ward, to test the sustainability of the project. The completion of the tool requires facilitation.
2. HCAI Sustainability Assessment Tool – Scoring Sheet
The HCAI Sustainability Scoring Tool is for the project lead to use as a scoring aid. The tool scores are weighted and based on the NHS Institute for Innovation and Improvement Sustainability scores.
Sustaining HCAI Reductions – Assessment Tool – Scoring Sheet (PDF, 50.2 KB)
3. HCAI Sustainability Tool – Excel Scoring Sheet
The HCAI Sustainability Excel Scoring Sheet is also used by the project lead. The project lead would enter the individual scores in the database in order to obtain the final overall scores for the project. Actions would then need to be implemented depending on the areas highlighted for future development.
4. HCAI sustainability workshop
For further information about how to plan for sustainability before, during and after any project, refer to the presentation below. This presentation will:
- Explore ‘what is sustainability?’
- Identify what can be done before, during and at the end of a HCAI project to ensure and maintain sustainability
- Introduce the DH HCAI Sustainability tool
Sustaining HCAI Reductions – Workshop (PDF, 91.8 KB)