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Table 4 Examples of the categories of ‘Sustainability of the interventions and conditions and strategies for this’

From: Can care coordination across levels be improved through the implementation of participatory action research interventions? Outcomes and conditions for sustaining changes in five Latin American countries

4.1. Sustainability of the interventions
- Desire for the implementation of the interventions to continue
What we hope is that the strategy will continue, that there’s no obstacle big enough to make it cease to exist, and that hopefully it can be rolled out in other places. The benefits are so great, when I talk to doctors from other networks that don’t have this space [joint meetings] ...and it’s difficult to attain, and now that we’ve attained it, well we mustn’t lose it” (PP, Colombia)
- Institutionalization of virtual consultations
I think that including these consultations in the planning is something that has undoubtedly favoured the rollout of these events. That we now have instructions and previously allotted times to dedicate to this kind of activity, that was a step that really facilitated participation” (Healthcare professional, Chile)
- Facilitators of the sustainability of the joint meetings: alignment with/incorporation into state policy, favourable results and professionals’ interest in the interventions
“Because they’re also very much in keeping with what the ministry authorities, more than any one particular government, have been promoting. It’s in line with telemedicine, with the optimization of the network” (Healthcare manager, Chile).
“The intervention itself should be maintained at the healthcare network level because when you read over what’s set out in the integrated health model, in part 9, in the model on human talent development, it states the need and even outlines the set of problems encountered regarding the level or quality of training that health personnel currently get (…) So this strategy becomes an opportunity” (LSC, Colombia)
Yes, totally sustainable, I mean, the main point is the productivity of doctors, but we have to look beyond productivity… the outcomes, not in the short term but in the medium to long term that this can have in terms of avoiding complications for the patients. It’s not unknown that having trained and happy staff will facilitate any job, so, we’ve got to look a bit beyond the money …” (PP, Colombia)
4.2. Threats or difficulties for the sustainability of the joint meetings
- Lack of management’s support for their maintenance
“I think that the managers don’t see it as being something productive for them... the management doesn’t see that the training of professionals is important as a way of improving the financial side, so they have to see clearly that unifying criteria reduces costs, when they see that as important, they’ll promote those spaces, but if they don’t think that has an impact, it’s going to be difficult” (PP, Colombia)
- Lack of institutionalization of cross-level visits
“For them to be continued, they’re not yet (...) an institutionalized tool, so for that they need to be included as part of the induction strategies that should be promoted by the services and by the establishment’s training or recruitment department” (Healthcare manager, Chile)
4.3. Conditions for the sustainability of the interventions
- Institutionalization of the interventions
“(…) it depends a lot on the government that’s currently in power, it depends on public policies, it also depends on [political] will, etc., however this work should be established as a type of protocol, that every so often we could roll out this training or deliver this information, especially for new people” (Healthcare professional, Chile)
- Institutional support
“I think it’s essential that the managers continue to incentivize this, give it their support, you know? Because that communication is important” (Healthcare professional, Brazil)
4.4. Strategies for the sustainability of the interventions
- Incorporation of the interventions into network planning/local policy
“basically it has to be a policy of the management, they have to see the importance, the need for these spaces for training and communication between specialists and general doctors. If not, then it’s really difficult, we go back to how we were before” (PP, Colombia)
- Allocation of resources
“(…) they have to define the structures, the processes and of course the resources to make it sustainable (...) to a large extent all they really need to do to is find a way to bring it all together in order to institutionalize it” (LSC, Mexico)
- Appointing staff to take charge and defining their roles in the implementation process
“so the idea is to maintain those connections, right? And that this becomes like a working method [PAR], that it’s not only...like at the moment, that it relies on people’s good will, because maybe tomorrow, I don’t know, XXX leaves (…), so then we have to put someone else in. I retire, another person comes in (...) I mean the idea is that this is what we do, so it’s part of the role, it’s part of your function, it’s part of your job to do this, this is just one more of your duties, it’s not like it’s just out of sheer good will” (Healthcare manager, Chile)
- Making processes and spaces official
I think it’s important to make progress in systematizing and making the processes more official, (...) so that if someone were to say, ‘no, maybe we should scrap it [the intervention]’(...) that things are more...official [in terms of processes, roles, resources, etc] so that it blocks that in some way” (LSC, Chile)
- Raising awareness of the usefulness of the intervention through disseminating its results and evaluating its cost-effectiveness
“start to get them [healthcare managers] involved, start to tell them, ‘look how important it is’. And then show them the results (...) that’ll motivate them a bit, and also motivate them in terms of the benefits it’ll bring for the patients and for themselves” (Healthcare manager, Colombia)
“Because they haven’t translated it into numbers, they haven’t put it into financial figures… because it’s expressed in figures like adherence to patient care protocol, coverage, commitment to care … but if they published financial data, they would see the importance” (PP, Colombia)