Table 4.

Factors that hinder sustainment

Hailemariam et al.’s Hindering Factors	Wiltsey Stirman et al.’s Framework	Fully Sustained	Not fully sustained	Example quotation
Workforce	Capacity	3	9	“Staffing is the largest hurdle as to why buy in is not 100%”
Not able to maintain EIP fidelity/integrity	Innovation characteristics	0	3	“Many of the tenants from the [EIP] have stopped”
Critical incidentsa	Outer Settinga	1	3	“Shortage of nursing staff during pandemic”
Organizational leadership did not support the sustainment of EIP	Context	0	2	“Lack of leadership buy-in to support”
No ongoing support	Processes & interactions	1	2	“The practice has partial support and buy in”
Lack of trained personnel to continue EIP	Capacity	0	2	“Champion left position”
EIP effectiveness or benefit not observed	Innovation characteristics	0	2	“Many [staff] don’t find the [EIP] to be effective”
Unable to navigate competing demands	Processes & interactions	0	1	“Other priorities in the program”
System/policy change	Context	0	1	“Our facility is including in [new] Initiative process”
Poor collaboration/partnership	Processes & interactions	0	1	“Disconnect between [clinic] and [other] service.”
Other	Lack of adequate service users	0	1	“[Event] in use, however due to the low census, no qualifying Veterans at this time.”
No/limited funding	Capacity	0	1	“Funding [barrier]”
No ability to modify/did not modify EIP	Innovation characteristics	0	1	“Transitioning practice to a different format”
Internal/external champion did not support the sustainment of EIP	Capacity	0	2	“The [champion] is a problem who falls under our [leadership].”
Community stakeholders do not support the sustainment of the EIP	Capacity	1	1	“Buy in from some community providers has been challenging”
Totalb		6	32

^aNot present in Hailemariam et al.’s factors

^bTotals are based on 66% (39/59) of facility representatives who provided brief, open-ended text box responses in the 2021 survey. Some responders had provided more than one type of barrier