Framework 3: The Dynamic Model of Health Program Sustainability Framework

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The Dynamic Model of Health Program Sustainability is a framework that emerged out of data collection and analysis of complex changes to the primary and secondary care of stroke, kidney, and sexual health patients in London, England (Greenhalgh, MacFarlane, Barton-Sweeney, & Woodard, 2012). The framework draws on intervention-focused and system-dynamic perspectives (Greenhalgh et al., 2012) and is adapted from the frameworks of others (e.g., Ovretveit, 2011; Scheirer & Dearing, 2011; Bisset & Potvin, 2007; Gruen et al., 2008).

The authors found that whether health systems were able to sustain original programs during periods of change was dependent on:

1) stakeholders’ conflicting and changing interpretation of the targeted health need; 2) changes in how the quality cycle was implemented and monitored; and 3) conflicts in stakeholders’ values and what each stood to gain or lose (Greenhalgh et al., 2012, p. 517).

The authors believe that this framework could be useful to other healthcare administrators who are planning to implement a complex change and who must balance continuing past practices and adapting to changing contexts (Greenhalgh et al., 2012).

The dynamic model of health program sustainability is adapted from Gruen and colleagues (2012). Figure 3 below presents the components that should be considered when balancing sustainability of existing programs and complex system change. The 3 hexagons represent intervention focused domains.

These domains are:

  1. What are the main health concerns in the target population?
  2. What are the components of the program (e.g., service models) and the infrastructure supporting these components (e.g., information systems, monitoring metrics)?
  3. What positive forces (e.g., good managerial relations) are driving the program forward, and what negative ones (e.g., competition for limited resources) are holding it back? [Greenhalgh et al., 2012, p. 521]

The curved arrows in the model represent 3 dynamic components of sustainability:

  1. Changes in definitions and interpretations of health concerns over time
  2. Changes in how the program is delivered and monitored over time
  3. Changes in how stakeholders engage with the program and nature/extent of local political struggles (Greenhalgh et al., 2012, p. 521).

Figure 3. Dynamic Model of Health Program.png

Greenhalgh, T., MacFarlane, F., Barton–Sweeney, C., & Woodard, F. (2012). If we build it, will it stay? A case study of the sustainability of whole-system change in London. The Milbank Quarterly, 90(3), 516–47.

Chambers, D., Glasgow, R., Stange, K. (2013). The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implementation Science, 8:117.

Last Updated: 06/28/2017