Table 2 Sustainability factors at the nursing department level

 Relevance of the program

• “[The BPG program goals are] a continuing, evolving preoccupation within the organization.” (O09)

• “[The program] is an important commitment that focused specifically on the work that nurses do.” (O13)

• “The program addressed the issues in a bigger picture way. Not like a band-aid solution, but a longer-term solution.” (O04)

Positive

 Nature of the program

• “Now that we have more and more research… we really need to keep it up there. If we’re doing something, there has to be a reason why we’re doing it in a particular way…” (O05)

• “It’s our responsibility as an academic nursing group to use evidence.” (O02)

Positive

 Extra-organizational partnership

• “That we were a [RNAO] ‘Spotlight Organization’ (designation) sent a message that this is something big.” (O06)

Positive

 External pressure for performance

• “We now have some external benchmark data that we’ve never had before, that shows that we’re not as good as we thought we were. And so we can make more progress. That kind of pressure…” (O11)

• “In Canada there’s going to be some more benchmarking, and hospitals comparing themselves… not only the [university health centre] group, but something bigger. So we know that we have to improve.” (O06)

Positive

 Financial resources

• “Financially, [the nursing department’s] hands are tied. … We don’t have a budget [for the program], but we still need to do that job. It becomes more and more difficult.” (O05)

Negative

 Interprofessional collaboration

• “Although we talk about it being interprofessional, it was a lot of around nursing.” (O12)

• “Why aren’t some of the other disciplines–pharmacy, medicine, physiotherapy…–involved anymore? They were participating more at the beginning, or when we needed them…They’re no longer there at the table.” (O09)

Negative

 Nursing department culture

• “It’s the culture. The [nursing department] hasn’t really formed its own… I don’t know how successful we’ve been in taking up a sort of identity that we can be proud of.” (O10)

• “We do not have that culture of zero tolerance (for substandard care). Think we’re ready to take that responsibility? Far from that.” (O04)

Negative

 Co-directorship of the program

• “The working closely together between practice and research [leadership] was also a factor…” (O12)

• “[The director of nursing] is trying to put this kind of structure of … best practice guidelines… and making it better for the patient… She’s imposing a structure that we never had.” (O01)

• “[The research director] was at arm’s length… could ask good questions… non-territorial… a well-informed voice” with “willingness to path-find.” (O13)

Positive

 Commitment of several nursing leaders to the program

• “It’s the ongoing presence of a core team of really committed nursing leaders… who have been involved for a long, long time… People who really took it seriously.... relentless, pushing, never giving up.” (O02)

• “The other thing that’s kept it going is the commitment of the leaders. I think if they weren’t so stubborn, and didn’t continue to pull people together, and didn’t continue to push [the program would not have been sustained].” (O11)

Positive

 Complementarity of leadership actions across the department

• “Everybody has to see it as important in their work, because it’s all like a chain. And if one [chain link] is weak … then obviously the rest could fall.” (O06)

• “If you want to sustain change, you have to have leaders working at various levels of the organization. It’s textbook out of sustainability 101.” (O02)

Positive

 Reflection-and-course-correction strategy

• “The idea of continually revisiting and almost reshaping [the BPG program] is the name of the game” (O10)

• “We cannot sit on it and pretend because we’ve changed… it’s a done deal. It never ends…” (O04)

Positive