Holding the Gains: A Brief for Tribal Home Visiting Grantees

How can programs make improvements that last?

This brief explains how to build on continuous quality improvement (CQI) projects, how to know when to move from testing changes to implementing them, and how to sustain the changes. Three steps—increasing staff readiness, hardwiring the change, and monitoring results over time—are essential for effectively implementing change. Within these steps, key sustainability factors foster integration into standard practice: leadership, perceived value, communication, organizational infrastructure, staff, measurement, and feedback.

Teams that decide to adopt successful changes can apply these concepts to hold CQI gains over time. They should examine how the implementation steps and sustainability factors align with their program and make adaptations where necessary.

The brief was designed for Tribal Maternal, Infant, and Early Childhood Home Visiting grantees and includes knowledge and examples based on their projects, but it is also applicable to health and human services programs in other contexts. It includes a list of additional resources and a glossary of key terms.