Always Work Towards Sustainability

When we’re not talking about something, people can forget about it.

– Senior Nurse Manager


Create Lasting Change

Creating organizational change requires a great deal of collective motivation and energy. Making sure all that energy isn’t spent on a short-lived effort requires thinking through approaches for harmonizing with larger agency initiatives and ways to embed the project into the organization’s systems.

We’ve previously discussed harmonizing with agency goals. Doing so doesn’t just increase the project’s chances of being taken seriously, but it also contributes to its ability to remain over the long term. Beyond the big picture, also think about where the project can be included in written policies and procedures, and EHR and dashboard modifications so that it becomes an integral part of the agency’s systems. For example, once you have a written policy for standing orders for MA’s to offer HIV tests, it becomes part of the organization’s official policies, making it harder for staff to stop doing.

Changes to staff knowledge and culture are supported by all the system-level changes you make, but they are also bolstered through training activities. Even training can be “systematized,” for example by embedding it into annually scheduled requirements for continuing education.


Focus on the Journey

Achieving universal HIV screening is not a one-time effort. It will continue over time. Once the initial implementation push runs its course, the project should not disappear completely. Instead, it should enter a “maintenance” phase where all the systems put in place to sustain it keep running. Unfortunately, it’s not quite that simple. Things will change- new EHR templates will be developed, new test types will be recommended, etc. Each time something happens that affects HIV screening procedures, the project needs to spring back into a more active phase to address it. Once that’s done, it can return to a maintenance state.


Look for this Icon

Throughout this toolkit, we’ve identified text and resources that address the challenge of making universal HIV testing sustainable. Many of these are found under the Systems section, but there are also important things you can do to make culture change sustainable, so you’ll find this icon in the Culture & Knowledge section as well.