The key components of step 7 include considerations toward future audits and sustainability, as well as scaling up the project.
The time frame for subsequent follow-up audits is up to the organisation, but we suggest a minimum of yearly . Table 5 provides a rough guide for how to determine the frequency of follow-up audits. Careful analysis of the current results against preceding results helps identify other areas that may need further analysis. In addition, this becomes an excellent avenue for capacity building. Core members of staff can become actively involved in auditing their practice against the identified best practice standard.
Table 5: Generic guide for determining timing of subsequent audits
Compliance with standards <50%
Compliance with standards 50-80%
Compliance with standards 80-100%
Audit every 3 months 3 monthly audits
Audit every 6 months
Audit every 12 months
Sustainability refers to the capability of maintaining and sustaining evidence-based practice beyond the implementation project; it is a growing field within implementation science. Sustainability cannot be achieved without the change being embedded into the organisational norms/culture (Khalil 2017). Several emerging factors associated with sustainability include context (e.g. policy and legislation, leadership, staffing, funding), intervention characteristics (adaptability, need, complexity), processes (engagement, training, capacity building) and implementer population characteristics (skills, expertise, attitudes, motivation) (Shelton, Cooper & Stirman 2018).
The project team cannot nor should not be responsible for the ongoing clinical audits. Instead, this repeat audit responsibility needs to be handed to another. Ideally this other team is a Practice or Continuous Quality Improvement Committee who have the authority to conduct random audits and the expertise to constructively review and manage the results, or who are able to embed the data collection within current workflows and processes via an automated system.
Maintaining evidence-based practices is critical to achieving health benefits; therefore, consideration of a project’s sustainability is important (Shelton, Cooper & Stirman 2018).
Scaling up can be defined as “deliberate efforts to increase the impact of successfully tested health innovations so as to benefit more people and to foster policy and program development on a lasting basis” (p.2) (World Health Organisation 2010). Attention should be given to how best to scale up an implementation project from a local, small-scale clinical audit project to one undertaken on a much broader scale.
Careful consideration, strategic planning and management is required, and should focus on
thoughtful resource allocation, whether the location/setting is similar enough to the original implementation project site, and how members from new sites can be included with any new initiatives (World Health Organisation 2010).