Identifying factors influencing sustainability of innovations in cancer survivorship care: a qualitative study.


Urquhart R(1)(2)(3)(4), Kendell C(4), Cornelissen E(5), Powell BJ(6), Madden LL(2), Kissmann G(7), Richmond SA(3)(8), Bender JL(3)(9).
Author information:
(1)Community Health and Epidemiology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada [Email]
(2)Surgery, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.
(3)Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
(4)Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
(5)Department of Family Practice, The University of British Columbia Faculty of Medicine, Kelowna, British Columbia, Canada.
(6)Brown School, Washington University in St Louis, St Louis, Missouri, USA.
(7)Information Management & Decision Support, Interior Health Authority, Kelowna, British Columbia, Canada.
(8)Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada.
(9)Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.


OBJECTIVES: Moving innovations into healthcare organisations to increase positive health outcomes remains a significant challenge. Even when knowledge and tools are adopted, they often fail to become integrated into the long-term routines of organisations. The objective of this study was to identify factors and processes influencing the sustainability of innovations in cancer survivorship care. DESIGN: Qualitative study using semistructured, in-depth interviews, informed by grounded theory. Data were collected and analysed concurrently using constant comparative analysis. SETTING: 25 cancer survivorship innovations based in six Canadian provinces. PARTICIPANTS: Twenty-seven implementation leaders and relevant staff from across Canada involved in the implementation of innovations in cancer survivorship. RESULTS: The findings were categorised according to determinants, processes and implementation outcomes, and whether a factor was necessary to sustainability, or important but not necessary. Seven determinants, six processes and three implementation outcomes were perceived to influence sustainability. The necessary determinants were (1) management support; (2) organisational and system-level priorities; and (3) key people and expertise. Necessary processes were (4) innovation adaptation; (5) stakeholder engagement; and (6) ongoing education and training. The only necessary implementation outcome was (7) widespread staff and organisational buy-in for the innovation. CONCLUSIONS: Factors influencing the sustainability of cancer survivorship innovations exist across multiple levels of the health system and are often interdependent. Study findings may be used by implementation teams to plan for sustainability from the beginning of innovation adoption initiatives.