Chapter 5: Review, expansion and sustainability
It may be that your effort to improve care for frail older patients secures funding for an initial, time-limited period. A review at the end of that period will be an opportunity to show the contribution of your work to improving care rather than a prelude to ending the service.
Services that not only receive continued funding but expand their capacity often build their success on committed use of evidence in reviews, and sharing this evidence widely to ensure a growing buy-in from funders and colleagues.
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“We started [as] a funded project about 12 years ago with funding for 2 years for a registrar, clinical nurse specialist, an OT and a social worker. That was it essentially. And [we] started in orthopaedic elective patients only. [After] having shown a reduction in post-operative complications and improvement in length of stay without an increase in readmission, the Trust continued to fund the service, and has gradually supported the expansion of the team. [We now] cover all of the surgical subspecialties at [organisation 1]; the only one we don’t cover at the moment are cardiothoracic.” (Consultant Geriatrician)
“We were getting a lot of resource and a lot of support because we were doing what was evidenced, and we evidenced it was making an impact” (Consultant Geriatrician)
Sustainability can be vulnerable when efforts are seen as ‘projects’ or when they rely on particular individuals. From an early stage, projects need to identify future funding sources, or identify ways to use resources more efficiently in order to sustain improvements. Successful outcomes should be written into standards, guidelines and procedures to ensure they are embedded in routine activities.
Considering the side effects of change
It’s not uncommon to successfully target one issue but also cause new problems elsewhere. This can cause people to lose faith. Be vigilant about detecting unwanted consequences and be willing to learn and adapt.
The NHS Model
National Audit Office Guide: Initiating successful projects, 2011 https://www.nao.org.uk/report/nao-guide-initiating-successful-projects-3/
Developing Informatics Skills and Capability http://www.hscic.gov.uk/disc
Portfolio, Programme and Project management (P3M) Resource Centre http://systems.hscic.gov.uk/p3m/resource/index_html
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