Sustainability Frameworks and Tools

Sustainability frameworks in detail:

  • Dynamic Sustainability Framework (DSF): emphasizes that change exists in the use of interventions over time, the characteristics of practice settings, and the broader system that establishes the context for how care is delivered (Chambers et al 2013). The model comprises of the intervention, the context in which the intervention is delivered, and the broader ecological system within which the practice settings exist and operate. DSF emphasizes the idea that change is constant, and that there needs to be a continuous process for optimizing the “fit between the intervention and a dynamic delivery context to achieve maximal benefit” (Chambers et al, 2013). The DSF consists of seven tenets: “1) An intervention should not be optimized prior to implementation, or even prior to ‘sustainability phase’ onset; 2) Interventions can be continually improved, boosting sustainment in practice, and can enable ongoing learning among developers, interventionists, researchers and patients; 3) Ongoing feedback on interventions should use practical, relevant measures of progress and relevance; 4) Voltage drop is NOT inevitable; 5) Programs should be more likely to be maintained when there is strong ‘fit’ between the program and the implementation setting; 6) Organizational learning should be a core value of the implementation setting; 7) Ongoing stakeholder involvement throughout should lead to better sustainability” (Chambers et al, 2013).
  • Framework for public health program capacity for sustainability: The framework presents nine domains specific to public health interventions that are essential for success. It can be used to assess a program’s capacity for sustainability for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers to consider when developing and implementing prevention and intervention programs: 1) Political Support; 2) Funding Stability; 3) Partnerships; 4) Organizational Capacity; 5) Program Evaluation; 6), Program Adaptation; 7) Communications; 8) Public Health Impacts, and 9) Strategic Planning (Schell et al, 2013).
  • The Practical, Robust Implementation and Sustainability Model (PRISM) model (Feldstein et al, 2008): uses concepts from the quality improvement, chronic care, and the diffusion of innovations along with measures of population-based effectiveness interventions. It includes key elements to consider when implementing evidence-based practices and key questions to enhance implementation and sustainability for each domain. The domains include: Program (Intervention) – organizational and population perspectives of the intervention; External environment; Implementation and sustainability infrastructure; and Recipients (organizational and population characteristics).
  • Program Sustainability Index (Mancini & Marek, 2004) is a 29-item program sustainability index to assess six factors related to the sustainability of community-based programs.

Sustainability tools in detail:

  • The National Health Service (NHS) Sustainability model (Maher et al 2010): consists of 10 factors that may improve sustainability, and can be used by teams who are implementing new practice in their organization to identify strengths and weaknesses of the implementation plan of their innovation, and to predict the likelihood of sustainability (Maher et al, 2010). The sustainability guide offers practical advice on achieving sustained use of the initiative by providing the means for teams to address identified challenges and prompt discussion and action to address them, particularly across factors with maximum potential for improvement (i.e., largest difference between identified score and maximum potential sustainability score). The process is aimed at raising early awareness of sustainability challenges, and the opportunity for teams to iteratively address these challenges to optimize the new initiative’s potential for impact (Doyle et al, 2013). The model can be used in the planning and early stages of implementation to evaluate the likelihood that an innovation will be sustained, and it can also be used at any phase of a project


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

Doyle, C., Howe, C., Woodcock, T., Myron, R., Phekoo, K., McNicholas, C., et al. (2013). Making change last: Applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. Implementation Science, 8, 127.

Feldstein, A. C. & Glasgow, R. E. (2008). A Practical, Robust Implementation and Sustainability Model (PRISM) for integrating research findings into practice. The Joint Commission Journal on Quality and Patient Safety, 34(4), 228-243.

Maher, L., Gustafson, D., & Evans, A. (2010). NHS Sustainability Model. NHS Institute for Innovation and Improvement. Retrieved from

Mancini, J.A. & Marek, L.I. (2004). Sustaining community-based programs for families: Conceptualization and measurement. Fam Relat, 53(4),339-347.

Schell, S.F., Luke, D.A., Schooley, M.W., Elliott, M.B., Herbers, S.H., Mueller, N.B., et al. (2013). Public health program capacity for sustainability: A new framework. Implement Sci, 8:15.

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