The final step of the change process is to sustain the change in the “future state”. This step takes place in the normal operating system rather than being part of the active change cycle.

Why: Proactively sustaining a change is important to ensures that progress is not lost and things slip back to the pre-change state.

What: This step uses processes for maintaining quality, including ongoing data measurement and gathering feedback to assess the value and impact of the new model. Operating a Quality Management System supports sustaining change through its processes for maintain quality.

Up until this point, the change has taken place within one defined “test location” which could be a geographical location, a specific service or a defined group of people (service users or providers). Once the change output has been sustained in that test location and monitored to ensure it achieves a high quality and safe new model, it can then be reviewed to decide whether to spread or scale the new model to additional locations. It should be recognised that very few models can be “lifted and shifted” to new locations and therefore understanding the context of the new locations is essential before deciding whether the change has potential to spread and/or requires adaption.

How: Examples of tools that support the sustain step:

• Data measurement such as measurement plans, run charts and other data collection tools.
• Routine service feedback and other engagement tools.