Step 6: Sustain the Improvement Over Time

The sustainability phase requires on-going periodic monitoring of the clinic’s performance for the selected measures. It is important to establish a mechanism to ensure that those new system changes, and related outcomes, are sustainable and have not had unanticipated consequences. The following elements are important for an effective sustainability system:

• Choose a limited set of effective measures for monitoring. This may also include evaluation by staff.
• Establish a schedule for periodic monitoring and reporting. You will want to move on to other priorities when you are satisfied with the results, but also want to keep the momentum going, especially as new staff becomes involved.
• Develop report formats to communicate clearly.
• Establish a procedure for acting on any problems identified.
• Assess sustainability intervention(s) on a periodic basis.