After adoption: Sustaining the innovation - A case study of disseminating the Hospital Elder Life Program

OBJECTIVES: To examine key factors that influence sustainability in the diffusion of the Hospital Elder Life Program ( HELP) as an example of an evidence-based, multifaceted, innovative program to improve care for hospitalized older adults. DESIGN: Longitudinal, qualitative study between November 2000 and November 2003 based on 102 in-depth interviews every 6 months during HELP implementation. SETTING: Thirteen hospitals implementing HELP. PARTICIPANTS: Forty-two hospital staff members ( physician, nursing, volunteer, and administrative staff) implementing HELP, conducted 102 interviews. MEASUREMENTS: Staff experiences sustaining the program, including challenges and strategies that they viewed as successful in addressing these challenges. RESULTS: Of the 13 hospitals studied, 10 were sustaining HELP at the end of the study period; three terminated the program (after 24 months, 12 months, and 6 months). Critical factors were identified as influencing whether the program was sustained: the presence of clinical leadership, the ability and willingness to adapt the original HELP protocols to local hospital circumstances and constraints, and the ability to obtain longer-term resources and funding for HELP. CONCLUSION: Recognizing the need for sustained clinical leadership and funding as well as the inevitable modifications required to sustain innovative programs can promote more-realistic goals and expectations for health services researchers, clinicians, and policy makers in their laudable efforts to translate research into practice.