The purpose of the study was to describe differences in the organizational context between hospitals with high versus low RRT. Contextual differences that were examined include leadership, funding, and demonstrating program effectiveness.
Methods:
Study design and Measurement: A cross-sectional design using a survey methodology. Sustainability factors were measured using three sub-scales of the Program Sustainability Index (PSI) (Mancini & Marek, 2004), Thirteen items from the PSI were used to measure leadership competence (α = .81, 5 items), demonstrating program results (α = .85, 4 items), and strategic funding (α = .76, 3 items). Item response options ranged from 1 = strongly disagree to 7= strongly agree. Both individual item scores and composite sub-scale scores were evaluated for differences. RRT sustainability was measured using the Measurement Instrument for Sustainability of changed Work Practices (MISWP) (Slaghuis et al., 2011). Items were scored on a five point Likert scale (1=I don’t agree at all to 5=I agree very much). A dichotomous dummy variable was generated to reflect high versus low sustainability. Two additional questions, “To what extent does the RRT project meet the needs of patients?” and, “How confident are you that the RRT project will be active in five years?” were included to examine for middle-range RRT program results. Response options were measured on a 4-point Likert scale (not at all, somewhat, moderately, and fully). Sample: All the hospitals in a southeastern state in the U.S. that participated in a 9-month statewide collaborative conducted in 2006 and 2007 with the goal to successfully establish, implement, measure, evaluate, and sustain RRTs in acute care hospitals in the state. Nurse leaders of possible participating hospitals received an initial email between July 2014 and November 2014 asking them to complete the on-line survey, administered via REDCap. Non-responder hospital leaders received a follow-up reminder in one week and a
Results: Twenty-six hospitals participated in the study (Response Rate=46%). All hospitals offered 24/7 RRT coverage (n=26, 100%), had pre-determined RRT calling criteria (21, 81%), had an RRT order set (18, 69%), and had
Conclusion: The study findings indicate that leadership and demonstrating program results are important factors to consider for RRT program sustainability. Sustaining interventions, like RRTs, requires a thoughtful process of having a clear program vision and mission, planning for sustainability and strategies for program survival, and have program evaluation plans in place. Surprisingly, in contrast to other studies, no statistically significant differences were observed for the variable “Funding”. One of the possible reasons for this finding is that, unlike many other healthcare innovations/interventions, external funding was not available to adopt and implement these teams. Sustainability is important because of the investment cost surrounding the adoption and implementation of not only RRTs but many other healthcare innovations (e.g., electronic health records and TeamSTEPPS). Investment losses and opportunity costs result when hospitals fail to sustain innovations such as RRTs. Additional costs are also incurred when new processes must be adopted or a new innovation must be implemented when the previous one failed (Manfredi, Crittenden, Cho, Engler, & Warnecke, 2001; Young, 2006). This study adds to the body of literature on sustainability (Ament et al., 2312; Duckers, Wagner, Vos, & Groenewegen, 2011; King et al., 2013; Tricco et al., 2013) by demonstrating that leaders in healthcare settings play an important role in the sustainability of RRTs and likely other innovations/interventions. Similarly, developing evaluation plans prior to program implementation likely increases an organizations potential for demonstrating results of RRT implementation. Leaders are likely the ones who initiates the development of evaluation plans to support their decision to adopt and implement these teams. Having evaluation plans in place increases the potential for program feedback to stakeholders and RRT users, thereby increasing the likelihood for program sustainability.