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How to ensure that the intervention will remain in use in the long term?
Making the use of an intervention a well-established practice requires a long-term effort. Careful and systematic implementation aims to ensure that the intervention becomes well-established as part of the organisation’s operations.
The benefits achieved from the use of the intervention start to b come apparent at this stage at the latest. Ideally, both employees and customers perceive the intervention as useful and valuable.
1. Monitoring the use of the intervention
In the sustainment stage, the focus is on the systematic monitoring of the use of the intervention. The goals and methods of systematic monitoring have already been determined in connection with the preparation of the implementation plan. This also requires goal driven management and the ability to interpret and utilise data accumulated on the use of the intervention.
It is important to have regular discussions with employees about the use of the intervention in the organisation and as part of the work of professionals. The discussions provide an opportunity to offer employees support in questions related to the use of the intervention and to increase employee commitment to the use of the intervention.
The sustainment of the use of the intervention lasts as long as the organisation wishes to keep the intervention in use. If sustainment is not actively given attention, the use of the intervention will gradually diminish. If this happens, the effort put in and the resources spent on the implementation will go to waste.
Factors that contribute to the diminished use of an intervention over time
- Employees do not have the time or opportunity to use the intervention.
- Employees or supervisors trained in the intervention change jobs.
- The methods of sustaining the intervention have not been considered.
- There is insufficient discussion or communication about the intervention.
- The organisation has too many interventions to sustain.
- The use of the intervention is not monitored.
2. Supporting fidelity
It is not uncommon for interventions to drift over time as they are used by professionals. The most typical forms of drift include changes to the order, duration or emphasis of the intervention components, modifications to training content, increases to materials, and changes related to culture and language.
Interventions include components that must not be modified by an employee or organisation alone, as well as components that allow for more flexibility. While flexibility may contribute to making the use of an intervention more established, the careless modification of an intervention may diminish its effectiveness.
Read more about the systematic adaptation of psychosocial interventions here.
With this in mind, fidelity should be one of the factors that are monitored and assessed in the sustainment stage.
Various tools can be used to support the realisation of fidelity, such as the intervention manual, checklists, supervisor guidance and joint discussions.
Fidelity
- Fidelity means that the intervention is used as planned. The aim is for professionals to use the intervention as they were taught in the training.
- Adherence to the core elements of the intervention is an integral part of fidelity. The core elements are key to maintaining the effectiveness of the intervention. They must not be modified without careful consideration and cooperation with the purveyor organisation.
3. Maintaining contact with the purveyor organisation
Maintaining contact with the purveyor organisation is also an important part of the long-term use of an intervention. It ensures that the organisation stays informed of potential changes to the intervention and refresher training, for example. The purveyor organisation plays an important role in strengthening and maintaining fidelity.
The pillars of implementation
Main tasks:
- monitor the long-term use of the intervention
- solve challenges as they arise
- ensure that employees have the support they need for using the intervention
- organise new training activities as needed
Responsibilities: The core implementation team transfers the responsibility for the long-term monitoring and sustainment of the use of the intervention to the administrative implementation
leadership team when the active execution stage of implementation ends.
In this transition, coordinators play an important role in transferring information and ensuring continuity. At this stage, it is important to collectively evaluate how the implementation has gone
and assess the situation.
The management will subsequently engage in regular monitoring of data accumulated on the use of the intervention, obtained from various sources, and ensure that the employees have access to the long-term support they need to use the intervention.
Knowledge and capabilities required: Capabilities related to monitoring, knowledge-based management and implementation are particularly important.
- Supporting the motivation and capability of the personnel and ensuring opportunities to use the intervention need to be continued in the sustainment stage.
- It takes time to embrace the use of a new intervention, and difficulties in using the intervention are not a sign of failure.
- Keep the topic prominent collectively openly monitor the use of the intervention. React quickly to observations and feedback.
- Regularly discuss any difficulties experienced in the use of the intervention and the benefits derived from its use.
- Regularly revisit the subject among the management and supervisors to consider why the intervention is being implemented.
As part of other knowledge-based management, regularly and systematically monitor the use of the intervention and the extent to which it has become an established practice.
The execution of follow-up and tools
- Collect and analyse data on the use of the intervention from different sources. React to the data and utilise it in the development of operations.
- Monitor the accumulated data and discuss it with employees in unit meetings, for example.
Making entries in the client information system
- Monitor that entries on the use of the intervention are made in information systems as agreed. Update the instructions as necessary.
- Data collected on the use of the intervention can be monitored via the overview of mental health services developed by Itla and the National Institute for Health and Welfare if the intervention has a procedure code.