This study sought to broaden our understanding of the factors, contexts and processes that bring about the sustainability of innovations in hospitals. Rapid response teams (RRTs)--an innovation that brings critical care expertise to patients in crisis with the goal of improving quality of care--was examined. Guided by an adapted version of Shediac-Rizkallah and Bone's (1998) Planning Model of Sustainability, a two phased approach that incorporated both quantitative and qualitative methods, was used. In Phase One, to determine the level of RRT sustainability, an online survey was administered to a convenience sample of 56 North Carolina (NC) hospitals that had participated in the NC Hospital Association's RRT Collaborative. The RRT-Institutionalization Scale, based on Goodman, McLeroy, Steckler, and Hoyle's (1993) Level of Institutionalization Scale, was developed and used to measure sustainability. Thirty-three hospitals (58%) participated in the survey. Descriptive statistics were used to obtain information about organizational and RRT characteristics, and to calculate and then rank hospitals into quartiles based on their sustainability scores. The mean sustainability score for participating hospitals was 3.71 (range, 1.0 to 5.19). In Phase Two, a multiple case study approach was used to examine four cases (two hospitals in the highest and two in the lowest quartiles of sustainability scores) and gather in-depth data about the sustainability of RRTs in hospitals. Data were gathered using a brief hospital questionnaire, interviews with key stakeholder groups (leadership, RRT members, and RRT end-users), and documentation review. Cross-case analyses were conducted by comparing (a) the two high-sustainability hospitals, (b) the two low-sustainability hospitals, and (c) the two groups of high- and low-sustainability hospitals. The results indicated that the presence of PMOS and other factors, as well as certain contexts, and processes facilitated sustainability in hospitals. Several differences were found between hospitals that reported high levels of RRT sustainability and those that reported low levels of RRT sustainability. Based on these findings, a model of RRT sustainability was proposed. Further research is needed to test the applicability of this model to hospitals in other states in the U.S., other types of hospitals, and other types of innovations.Doctor of Philosoph
