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Health Promotion International Advance Access originally published online on November 1, 2004
Health Promotion International 2004 19(4):489-500; doi:10.1093/heapro/dah411
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HEALTH PROMOTION INTERNATIONAL Vol. 19. No. 4 © Oxford University Press 2004; All rights reserved.

PERSPECTIVES

Program sustainability: focus on organizational routines

P. Pluye1, L. Potvin2, J. L. Denis2 and J. Pelletier3

1Department of Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, Quebec, Canada, H3A 1X1, 2Groupe de Recherche Interdisciplinaire en Santé, University of Montreal, PO Box 6128, Downtown Station, Montreal, Quebec, Canada, H3C 3J7 and 3Régie Régionale de la Santé et des Services Sociaux du Bas-Saint-Laurent, Centre Hospitalier du Grand Portage, 75 St-Henri Street, Rivière-du-Loup, Quebec, Canada, G5R 2A4

Address for correspondence: Pierre Pluye, Department of Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, Quebec, Canada, H3A 1X1 E-mail: pierre.pluye{at}mail.mcgill.ca

Program sustainability is an ongoing concern for most people in health promotion. However, the current notion of sustainability in organizations, namely routinization, needs refinement. This article examines organizational routines. In so doing, it refines the notion of sustainability and the assessment of routines. Drawing on the organizational literature, a routinized program is defined by the presence of routinized activities, meaning that these activities exhibit four characteristics of organizational routines: memory, adaptation, values and rules. To answer the question of how these characteristics are useful, we conducted an empirical study of the routinization of the Quebec Heart Health Demonstration Project in five community health centers. Our method consisted of a multiple-case study. We observed project activities in each center in 2000. The data came from documents and interviews with project actors. Our results show that, in one of the centers, no resources had been officially committed to project activities. Even so, the actors continued some activities on an informal basis. In another center, the activities satisfied three of the four routine characteristics. In the three others, activities satisfied all of the characteristics. These results suggest focusing the study of program sustainability on the routinization of activities resulting from it. They indicate four distinct degrees of sustainability: (1) the absence of sustainability; no program activity is continued; (2) precarious sustainability; some residual activities are pursued, at least unofficially; (3) weak sustainability; the program produces some official activities that are not routinized; and (4) sustainability through routinization; routinized activities result from the program.

Key words: program sustainability; organizational routines; organizational learning


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