PRISM Implementation and Sustainability Infrastructure

Implementation and Sustainability Infrastructure is defined as a dynamic support structure that can facilitate initial intervention adoption, implementation, and sustainability. This domain is relatively unique among dissemination and implementation context frameworks. It specifically calls out setting issues that are likely to be key to whether a program, intervention, or implementation strategy is sustained. This infrastructure is thought of as internal to the implementation setting and can be characterized by systemic relationships or hierarchies, communication patterns, performance measurement, and the sharing of data and best practices.

This concept includes both implementation and sustainability to bring attention that infrastructure support is needed across the continuum from initial adoption of an evidence-based intervention through the long-term maintenance of implementation. It also has a focus on the dynamic nature of the infrastructure to both systems needs and adaptations of evidence-based approaches as they move through the process of adoption, implementation, and sustainment.

The Implementation and Sustainability Infrastructure will dynamically change and should be evaluated on an ongoing basis. Successful implementation requires a carefully crafted infrastructure. The initial support structure can be modified over time as the project moves from implementation to maintenance, but the key, as stated earlier, is to plan for sustainability from the start. The relationship and communication between the individuals in this infrastructure and frontline adopters appear important.

The maintenance infrastructure needs to address periodic performance review and adjustments to infrastructure, protocols, and procedures. Often, this is forgotten soon after initial implementation. Careful consideration of sustainability infrastructure needs during implementation may smooth the way for long-term program maintenance.

Key elements of the PRISM Implementation and Sustainability Infrastructure domain include: