Sustainability in Implementation Science 

It takes about 17 years for evidence-based interventions to reach clinical practice — and the people who need them most. With that kind of investment, making programs that last becomes critical. Lasting implementation science programs have made diabetes prevention more accessible, surgeries safer and veterans healthier in mind and body. 
 
If you’re considering a career in implementation science, understanding sustainability is essential. In this article, we’ll explore three major programs that have succeeded over time and the decisions that led to their long-term success and sustainability.  

What Is Sustainability in Implementation Science? 

Sustainability in implementation science means keeping evidence-based programs working long after they launch.  

Implementation science puts solid research behind treatment. But what happens after implementation? Ongoing support, flexibility and embedding programs into existing systems are key to lasting impact. Let’s explore some real-world examples of sustainability in implementation science. 

1. Sustaining Diabetes Prevention Programs Across the U.S. 

More than 38 million Americans have diabetes — and those are just the people who’ve been diagnosed. The debilitating and potentially deadly disease has been extensively researched. 

In 1996, the National Institutes of Health (NIH) supported the launch of a clinical trial called the Diabetes Prevention Program (DPP). Tested across 27 facilities, the “Lifestyle Balance” program helped participants reduce their incidence rate of diabetes by 58%.  

How? Through a combination of: 

• Behavioral intervention 
• Lifestyle coaching 
• Regular interaction with participants 
• Individually tailored strategies 
• Educational materials targeting different ethnic groups 
• Local and national training, feedback and clinical support networks for facilitators 

But this was 1996. Could the program last? 

Yes, because the program planners built in sustainability from the start. They created training systems and support networks that could scale. When Congress directed the Centers for Disease Control and Prevention (CDC) to form the National Diabetes Prevention Program (NDPP) in 2010, those systems were ready to expand. 

The key to success: The NDPP didn’t just share research findings. It provided a complete framework — curriculum, training materials and ongoing support — that health systems and community organizations could actually use. With federal reach and influence, the NDPP spread across the U.S., making it easy for organizations to adopt and stick with the program. 

Today, the YMCA continues this vital work through their own diabetes prevention program. Their year-long, classroom-based program includes: 

• CDC-approved curriculum 
• Lifestyle coaches 
• Group discussions on: 
  • Removing roadblocks to a healthy diet 
  • Increasing daily physical activity  
  • Developing an action plan for sustainable behavior change 

2. Making Surgery Safer: The WHO’s Surgical Safety Checklist  

Sometimes surgery is the only way to treat a disease or injury. But it’s not without risks. Complications from infections, permanent disability or death can occur. What’s the solution? The World Health Organization (WHO) set out to find a sustainable answer. 

In 2007, the WHO launched Safe Surgery Saves Lives with a goal: develop minimum surgical safety standards for the entire world. It took two years and the input of an international team, including: 

• Surgeons 
• Nurses 
• Infectious disease experts 
• Epidemiologists 
• Biomedical engineers 
• Quality improvement professionals 
• Patients and patient safety advocates  

The result? A step-by-step checklist recognized worldwide by organizations representing many medical disciplines. It covers critical topics, such as making sure: 

• The correct, consenting patient is on the table 
• The patient is properly anesthetized 
• All necessary equipment is working 
• All personnel share any concerns about post-op patient recovery 

This checklist succeeded because it was simple and flexible. Rather than creating rigid regulations, the WHO offered guidance that any hospital could adapt to its own needs. It also included an FAQ and “how-to” guide to ease implementation. 

But 2008 — the official launch date — was a long time ago. How did the WHO keep the checklist relevant? 

The WHO understood the need for adaptation and published a checklist adaptation guide alongside the safety checklist, a speaker’s kit, a starter kit and other important materials. These keep the checklist relevant and in wide use today. And with PDFs as a primary resource, sharing and training remain simple and costs low. 

3. Sustaining Mental Health for Veterans  

Veterans experience higher rates of mental health issues than other people, but many don’t get the treatment they need. Some lack access. Others fear the stigma. 

In 2007, the Veterans Health Administration (VHA) launched the Primary Care-Mental Health Integration (PC-MHI) program. It boosted efficiency, allowing patients to see a primary care doctor and mental health clinician in the same office during one visit. This better enabled the practice to treat the whole person: extra care veterans often need. 

On a typical visit, a nurse or social worker delivered evidence-based treatment, such as: 

• Psychoeducation 
• Depression or anxiety symptom assessment  
• Guideline-based recommendations for patients on medication 

By late 2010, PC-MHI had completed more than one million patient encounters. Today, the Veterans Affairs department continues to offer PC-MHI and cites more than 20 years of research to back its results.  

The program has lasted because of ongoing financial investment in training, education, technical assistance, quality improvement tools and workload monitoring. The VHA treated sustainability as an ongoing commitment, not a one-time achievement. 

Build Your Implementation Science Career With the Right Credential 

The programs discussed in this article didn’t succeed by accident. They worked because people understood how to make evidence-based interventions last. 

UF’s online Graduate Certificate in Implementation Science teaches you those strategies. You’ll learn how to adapt programs for different populations, build support systems and create interventions that keep working long after launch. These skills prepare you for careers in healthcare, public health, research and policy — anywhere evidence-based change matters. 

Ready to lead implementation science — and your career — into the future? Start your application! 

Sources: 
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01040-9
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-022-01252-1
https://www.cdc.gov/diabetes-prevention/index.html
https://cdn.who.int/media/docs/default-source/patient-safety/safe-surgery/starter_kit-sssl.pdf?sfvrsn=9cef94b8_7
https://www.va.gov/bedford-health-care/work-with-us/internships-and-fellowships/clinical-psychology-residency-program/primary-care-mental-health-integration

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Other articles you may be interested in:

• Why Virology Needs Implementation Science
• Exploring the Health Belief Model 
• Implementation Science in Low-Resource Settings 
• 4 Effective Leadership Skills You’ll Learn With an Implementation Science Credential 
• Scaling Up: Implementing Interventions on a Larger Scale