Getting to Outcomes: Step 10. Sustainability

Table of Contents

This step guides you through some questions to consider when making decisions about whether your organization should continue a program.

What Is This Step?

This step will help you think through whether and how you can continue to deliver your program over time so that you reach the goal and desired outcomes established during GTO Step 2. Sustainability involves a deliberate effort to integrate the core elements of the program into the routine of your organization. This may include difficult discussions with staff and community members about what to change and/or discontinue if programming is not meeting established goals.

GTO Step 10 contains one tool—the Sustainability Review Tool. However, you will rely heavily on many of the tools from GTO Steps 1–9 to guide your discussions about sustainability efforts and the completion of this tool.

You will consider two important questions during this step:

  1. What is working that should be sustained?
  2. How do we sustain activities that should continue?

Why Is This Step Important?

First, if the original problem still exists, and your program shows that it achieves outcomes, then there is still a need for your program. By sustaining the program, the organization and the future participants will continue to get benefits from the large investment in starting the program. Sustaining effective programs maintains the positive feelings that your successful program generated among staff, community, and funders and adds to your reputation for delivering quality programming using an EBPH approach.

Like planning to deliver program modules, sustainability should also be thoughtfully planned. The following are suggestions for improving sustainability that could be included in a sustainability plan.

Program documentation:
Make sure that all aspects of your program are documented so that key knowledge does not leave the program in the event of staff turnover.
Program effectiveness:
By creating and maintaining high visibility of programs that are showing positive results (through publicizing the activities and positive evaluation results of your program)‚ you can establish a reputation for effectiveness and increase your program’s likelihood of being sustained.
Program financing:
Programs that rely completely on a single source of funds are more vulnerable than those with a diversified funding base. Taking the following actions can improve your chances of sustaining your program: (1) plan initially for eventual funding cutbacks, (2) cultivate additional resources while the program is ongoing (e.g.‚ in-kind costs or low fees for services), and (3) adopt an entrepreneurial spirit in seeking additional support.
Training:
Programs that incorporate and train more people with ongoing jobs in an organization are more likely to have lasting effects. These employees can continue to provide programming, train others, and form a constituency to support the program. The more people there are who are trained to conduct the program in an organization, the more likely it is that the organization will be able to continue the program, even in the face of staff turnover. Keep in mind that if the only people who operated the program were those fully funded by the program grant or contract, no one would be left to carry on any of its useful components when the grant or contract funding was exhausted or those staffers left.
Institutional strength:
The strength of the institution implementing the program is related to sustainability. Institutional strengths include goal consistency between the institution and the program, strong leadership and high skill levels, and mature and stable organizations.
Integration with existing programs or services:
Programs that are stand-alone, or self-contained, are less likely to be sustained than programs that are well integrated with the host organization(s). In other words, if the program does not interact and integrate with other programs and services, the program will be easier to cut when the initial funding ends. Therefore, program personnel should work to integrate their programs rather than to isolate and guard them.
Fit within your community:
Your program should demonstrate value over preexisting programs. This will enhance your potential for sustainability of the program.
Program champions:
Program sustainability sometimes can depend on generating goodwill for the program’s continuation. Goodwill often depends on obtaining an influential program advocate or “champion.” This person can be internal to the organization (e.g., a high-ranking member of the organization) or external.
Direct oversight:
Simply put, a program will more likely continue when a staffer is directly assigned to manage it and knows that his or her supervisor will be asking about its progress.

How Do I Carry Out This Step?

Like Step 9, Step 10 involves a global or comprehensive review of (1) what you have done to date and (2) what you will do in the future to promote the program’s sustainability. In this section, you will address these questions, record your answers, and indicate the next steps needed to sustain your program.

Tip 10-1. Looking at the GTO steps with an eye toward sustainability

Each of the GTO steps provides a lens through which to assess different elements of sustainability. Here are some suggestions to guide your thinking on this important topic.

Tip 10-1. Looking at the GTO steps with an eye toward sustainability

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Getting Started

Continue to build relationships. Whether you are starting something new or refining an existing program, relationships are always important to your success. Get buy-in all along the way from a diverse group of participants.

GTO Step 1

Ensure that the selected program is based on real needs in the community. As needs change, assess whether and how your program can meet those changing needs.

Identify what sorts of resources you might need to sustain the success of the program.

GTO Step 2

Choose goals and objectives that are meaningful and important to program participants and your other stakeholders. Working toward goals that your stakeholders care about will help you gather support from your stakeholders to sustain the program.

GTO Step 3

Ground your efforts in what works. This will increase staff competence and confidence and help you deliver a strong program.

GTO Step 4

Take time to continually assess fit. The more congruent your program is with existing needs, resources, and characteristics in your community, the easier it will be to gain support for it.

GTO Step 5

Develop important capacities in an ongoing way. Training is important to ensure that your staff and volunteers know how to deliver a program. Ongoing training ensures that new staff are always up to date on your program and operations.

GTO Step 6

A good work plan tells your story. Developing and using a clear work plan optimizes your use of time, energy, and resources. It brings together all your research, assessments, goals, outcomes, and evaluation plans, which will help you track your work, communicate what you are doing, and more easily attain the goals of an effectively implemented program.

GTO Step 7

Process is important. Identifying strengths, weaknesses, and areas for improvement will increase your overall effectiveness, which helps build confidence in your program.

GTO Step 8

Positive outcomes are crucial. The centerpiece of sustainability is achieving positive outcomes. Clearly demonstrate the effectiveness of what you’ve done and tie it to your vision, goals, and the needs in your community.

Involve the participants. Collect stories, especially from those who have completed the program and feel it worked well for them.

GTO Step 9

Revitalize your work. Looking for ways to continuously improve what you are doing keeps your work fresh and current and strengthens your overall program.

GTO Step 10

Plan for sustainability. You won’t know where you are going on this important topic if you do not describe your goals and figure out how you’ll know when you get there.

Source: Hannah, McCarthy, and Chinman, 2011.

Tools Used in This Step

Sustainability Review Tool: Past Work

Sustainability Review Tool: Past Work

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Instructions

  1. Make as many copies of the tool as necessary for you and your co-workers to complete this task. The tool can be completed individually or as a group with one person as the recorder.
  2. Assign a person responsible for collecting the completed GTO tools, including notes containing the process and outcome evaluation data gathered in the course of the program. You will also want any written guidance (i.e., the manual) that came with your chosen program to help you complete this tool.
  3. Follow the questions and the guidance provided in each row. By answering each question, you will address what you have done to date and how you want to do things in the future.

Example

  • Completed by: Project team/manager
  • Date: September
  • Program: ROAD-MAP
What we have done in the past
Sustainability Review Tool: Past Work (filled out for demonstration purposes)
Questions (Use your GTO tools as you ask these) Answers (Yes or No and explain) Next Steps
Does the need for the program continue?
Consider whether the need for the program has changed or remains the same and whether there are any new concerns

Yes, older adults, especially those from other senior centers in Townville, still face enhanced needs for disaster preparedness, especially with regard to medication stockpiling.

Explain the need or enter “N/A” Seek funding to make the program an annual initiative of the LHD and older adult partners.
Are our results good enough to continue doing the program?
Look at your results and determine the program’s impact on the participants.

Yes, one desired outcome was met, and we saw a small increase that fell well short of our goal for the other.

Expand to other sites to continue to accomplish desired outcomes. Make improvements (see CQI plan) to reach prescription medication supply target.
What particular result can we use to justify the program?
Any goal or desired outcome that you achieved may be a good “result” to share with stakeholders to justify the program. Any dramatic improvement shown by your data is definitely a result you may want to share. Look at the Goals and CQI tools to see what desired outcomes were reached or exceeded.

Increase in number of participants with 7-day supply of water and other essential household items, and prescription medication supply improvement

Continue to share our results with LHD managers and other potential funders to support applications for additional funding to make the training an annual project.
What should we change about the way we do the program?
Using the data reports and the CQI tool from GTO Step 9, think about the process—recruitment, enrollment, attendance, logistics, etc.—and consider whether one or more of these activities could be strengthened or changed to be a better fit for your site and staff.

Need better recruitment strategies for different groups

Need to lengthen classes to cover all materials

Consult community leaders of targeted racial/ethnic groups to enhance recruitment strategies.

Schedule longer classes at sites.
Who knows the program and supports keeping it going here?
Consider which individuals at the site are champions of this program—i.e., influential people who really like the program—and are enthusiastic about it, including leadership. Should somebody else be brought on? Who is going to take the lead?

The LHD program manager, coordinator, and trainer all have experience running the program.

The executive directors and other leadership and volunteers at senior center sites also know and support it.

The LHD trainer is going on an extended leave, so we need to engage a replacement trainer who is well qualified to work with older adults.
Are the GTO tools completed and available to use in the future?
You need access to the completed GTO tools. This could mean getting electronic and paper copies from the person who completed them.

No

We need to scan all completed tools so that we have a digital file that can easily be shared.
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Sustainability Review Tool: Future Work

Sustainability Review Tool: Future Work

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Instructions

  1. Make as many copies of the tool as necessary for you and your co-workers to complete this task. The tool can be completed individually or as a group with one person as the recorder.
  2. Assign a person responsible for collecting the completed GTO tools, including notes containing the process and outcome evaluation data gathered in the course of the program. You will also want any written guidance (i.e., the manual) that came with your chosen program to help you complete this tool.
  3. Follow the questions and the guidance provided in each row. By answering each question, you will address what you have done to date and how you want to do things in the future.

Example

  • Completed by: Project team/manager
  • Date: September
  • Program: ROAD-MAP
What we will do in the future
Sustainability Review Tool: Future Work (filled out for demonstration purposes)
Sustainability Questions Answers Next Steps
Where will the GTO tools, the program evaluation, and the program manual and materials be kept?
Decide who will have access to them and consider how this is the same or different from other program materials at your site. Where do you currently keep them?

They will be kept in a program binder at our public health office.

Need to scan all hard copies to also have a digital file with all these materials. Email to all on the team.
Who will be in charge of making the program happen?
Also, think about who is trained to be the facilitator, how that decision was made, and what supervision would be necessary.

The program manager will remain in charge as long as she is working at the health department.

If current position changes, we will need to familiarize the replacement program manager.
Who else is in favor of and needs to be involved in keeping the program going?
Think about the staff, leadership, board members, and the community of youth.

LHD leadership

Executive directors and other leadership at senior center sites

Need to continually meet to ensure ongoing support of program.
Who will do the evaluation and pre-/post- surveys, track attendance, and monitor adherence?
When (how often) and to whom will the results be reported? Think about who could lead these activities (1 person or more—staff or an outside group). Think about how to organize the results and who needs to see them.
The team evaluator Engage evaluator again as soon as funding is secured for next round.
How much funding, if any, do we need for running the program?
Are there resources other than funds that are needed to run the program well (e.g., for recruitment, good attendance, supplies)?
The first iteration of program cost $14,000, but we can save on personnel in the future as we continue to use our trainers to deliver the program. Revise program budget and submit to LHD management to ensure that funding is available to keep the program running.
When will we run the program again? And when will we revise the Step 6 Work Plan?
Consider the different times of year or days and times of the week and what worked best in the past. Think about lead time needed to look back at the Work Plan and revise it for the future.
We are considering running the program again in a year Recruit additional sites earlier and start participant notification earlier.
How can we keep staff trained in the program?
The more staff are trained, the more likely you will be able to continue the program. Look back at the program materials and what is required of facilitators. Consider who could be trained and who would be responsible for doing the training.
Keep a health educator on board so that he or she can train additional volunteers to teach classes. Ask current trainer to help us find a replacement before she goes on leave.
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Step Checklist

When you finish working on this step, you should have:

  • Completed the Step 10 tool
  • Reviewed how each of the previous steps helps with sustainability
  • Identified at least one, if not more, respected program champions
  • Developed a sustainability plan

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Summary

This chapter briefly summarizes the ten steps of GTO and suggests that you complete any steps you may have skipped earlier.

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