Table 2 Examples of adaptations for spread and sustainment. Adaptations were driven by consideration of the Dynamic Sustainability Framework (Chambers et al, [9])
Adaptation for Intervention Spread and Sustainment: • Each site had different processes for tracking patients for follow-up visits. • Technology issues prevented a clinician from editing a shared team document to support routine follow-up with PAPT users. • The clinician created a new system to track, provide reminders and communicate with patients. • Their system informed improvements the original system to support tracking patients after discussion at a monthly team meeting. Take away: • Providing autonomy to champions can improve initial implementation processes. • Regular team meetings allowed for this process improvement to occur. Adaptation for Context (Practice Setting) Spread and Sustainment: • Specific example: Staff turnover is a common problem that can stall implementation, spread, and sustainment. • One new champion prioritized educating their colleagues about the program in an inservice and identified another therapist for a succession plan in case of a staffing change. Take away: • Staffing changes make continued program growth vulnerable. • Local opinion leaders and champions can help in addressing this by using the “train the trainer” method. Adaptation for Ecologic System (Outer Setting) Spread and Sustainment: • A global pandemic resulted in changes in the delivery of care included clinic closure and transition to telehealth. • The proactive physical therapy delivery pattern was performed entirely in-person prior to the pandemic, but was adapted to telehealth within 1 month of the outpatient therapy clinic closing to in-person care. • The clinicians were able to use monthly meeting times to discuss the modifications needed for a rapid and safe transition to telehealth. Take away: • A climate where clinicians felt supported and confident to suggest changes can accelerate adaptations to unpredictable challenges. |