| Course | D916 MHA Capstone |
|---|---|
| Task | Task 2 |
| Paper type | Program sustainability plan |
| Length | About 1,100 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | Master of Healthcare Administration |
| Updated | September 2026 |
Free sample paper for D916 Task 2
Still Running in Year Five: A Sustainability Plan for a Composite Hospital's Outpatient Parenteral Antimicrobial Therapy Program, Organized by the Seven Domains of Clinical Sustainability
Student Name
Leavitt School of Health, Western Governors University
D916: MHA Capstone, Task 2
Course Instructor
Month Day, Year
Still Running in Year Five: A Sustainability Plan for a Composite Hospital's Outpatient Parenteral Antimicrobial Therapy Program, Organized by the Seven Domains of Clinical Sustainability
What Sustainability Means for This Program
The business case for Lakeview General Hospital's outpatient parenteral antimicrobial therapy (OPAT) program showed that moving eligible patients' IV antibiotic courses out of the hospital could free about 1,830 bed-days a year and produce a net benefit of about $1.6 million annually. A program that delivers those results for one year and then fades when its champion leaves or its start-up funds run out would waste the investment. For this plan, sustainability means that five years from launch the program is still funded from a stable source, staffed by people who can replace one another, embedded in the hospital's routine discharge process, measured and reported, and adapted as conditions change.
The plan is organized around the seven domains of the Clinical Sustainability Assessment Tool, which was developed with clinicians to measure an organization's capacity to sustain clinical practices: engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness (Malone et al., 2021). The OPAT team will complete the tool at baseline and every year, so weaknesses appear as scores before they appear as failures.
Engaged Staff and Leadership
The program must not depend on one person. The infectious diseases group will name a medical director and a trained associate director, so that leadership continues through leave or departure. The two OPAT nurses will be cross-trained with the vascular access team, and the coordinator role will have written procedures that a new hire can follow. The chief medical officer remains executive sponsor for the first three years and will hand sponsorship to the vice president of care management once the program is established.
Engaged Stakeholders
Hospitalists, surgeons and case managers decide whether a patient is referred, so their confidence sustains the program. The OPAT team will present results at each department meeting twice a year and share patient stories alongside the numbers. Home infusion companies and skilled nursing facilities will have annual partnership reviews. A patient advisor who completed OPAT at home will sit on the program's oversight committee.
Organizational Readiness and Funding
Funding is the most common reason good programs end. The start-up cost of $150,000 comes from the hospital's capital budget, but the ongoing staff cost of $620,000 a year must have a permanent home. The plan places the program in the care management department's operating budget from year two, justified by the avoided inpatient days, and requires finance to report the program's savings each year in the same format used in the business case. The program will also pursue two revenue sources: billing for OPAT clinic and infusion services, and negotiating an OPAT case rate with the two largest commercial payers, which benefit from shorter stays. If savings in any year fall below program costs, the oversight committee must present a recovery plan to the finance committee rather than wait for a budget cut.
Workflow Integration
Programs survive when they become part of the normal way work is done. An OPAT screening question will be added to the hospital's daily discharge planning huddle and to the electronic health record's discharge navigator, so that every patient on IV antibiotics is considered automatically rather than only when a physician remembers. Referral, catheter placement, home infusion setup and first clinic appointment will be ordered through a single OPAT order set.
Implementation and Training
New hospitalists, residents, case managers and nurses will receive a short OPAT orientation during onboarding. The OPAT nurses will hold quarterly refreshers on catheter care for partner skilled nursing facilities. The program's patient teaching materials will be reviewed every year for readability and accuracy.
Monitoring and Evaluation
The program will report the same measures used in the business case, so trends can be compared from year to year.
| Measure | Target | Reported to | How often |
|---|---|---|---|
| IV-only inpatient days avoided | 1,830 a year by year two | Quality committee | Quarterly |
| 30-day readmissions of OPAT patients | No higher than the pre-program rate for similar patients | Quality committee | Quarterly |
| Catheter complications and adverse drug events | Below 10% of OPAT courses | Antimicrobial stewardship committee | Monthly |
| Net financial benefit | At or above program cost | Finance committee | Annually |
| Clinical Sustainability Assessment Tool score | Improving each year | Oversight committee | Annually |
Outcomes, Effectiveness and Adaptation
The program must adapt as patients, payers and evidence change. Two adaptations are planned from the start. First, patients with substance use disorders are often denied home-based OPAT and sent to skilled nursing facilities instead, and a two-center study found that those sent to skilled nursing facilities stayed longer in the hospital first and were less likely to be in addiction treatment 30 days after discharge (Hawes et al., 2026). Lakeview's program will develop a pathway with its addiction medicine service, including clinic-based infusion and treatment for substance use, so these patients are not excluded by default. Second, because structured OPAT programs with infectious diseases oversight have been associated with shorter IV courses and fewer adverse clinical outcomes (Manders et al., 2025), the team will use its monitoring data to review whether oral antibiotics can replace IV therapy for more patients, which could reduce OPAT volume while improving care.
Risks to Sustainability and Planned Responses
Four threats could undo the program, and each has a planned response. If referrals fall, the team will review the discharge navigator data to find which services stopped referring and meet with their leaders. If a major payer stops covering home infusion or changes prior authorization rules, the coordinator will shift affected patients to clinic-based infusion while the finance team renegotiates. If an OPAT nurse leaves, the cross-trained vascular access nurses will cover until the position is filled, and the written procedures will shorten orientation. If a national drug shortage affects a commonly used antibiotic, the pharmacist will work with the stewardship committee to choose alternatives suited to outpatient dosing.
Review Schedule
The oversight committee will review this plan every year, using the sustainability tool scores and the monitoring table, and will present a formal five-year evaluation to the board. The program should be considered sustained if, at that point, it is funded in the operating budget, led by a second-generation medical director, embedded in the discharge workflow and still meeting its targets.
References
Hawes, A. M., Yanek, L. R., Buresh, M. E., Abdel-Galil, R., Bodnar, A., Falade-Nwulia, O. O., & Keller, S. C. (2026). Outcomes in skilled nursing facilities versus other locations in outpatient parenteral antimicrobial therapy among patients with substance use disorders. Antimicrobial Stewardship & Healthcare Epidemiology, 6(1), e121. https://doi.org/10.1017/ash.2026.10364
Malone, S., Prewitt, K., Hackett, R., Lin, J. C., McKay, V., Walsh-Bailey, C., & Luke, D. A. (2021). The Clinical Sustainability Assessment Tool: Measuring organizational capacity to promote sustainability in healthcare. Implementation Science Communications, 2, Article 77. https://doi.org/10.1186/s43058-021-00181-2
Manders, I. G., Comello, D., Souverein, D., Euser, S., Herpers, B. L., Vetten, J., Kalpoe, J. S., Goeijenbier, M., & van Lelyveld, S. F. L. (2025). The impact of a structured outpatient parenteral antimicrobial therapy (OPAT) programme on quality of care, optimisation of antimicrobial use, and healthcare costs: A retrospective cohort study. Antibiotics, 14(11), 1103. https://doi.org/10.3390/antibiotics14111103
What the D916 Task 2 instructions ask
The second D916 task asks you to plan how your capstone project will be sustained. You will usually define what sustainability means for the project, address leadership, stakeholders, funding, workflow, training, monitoring and adaptation, identify threats and set a review schedule. The project must match the business case from Task 1. Graders want sustainability defined in measurable terms, a framework that organizes the plan, funding that moves from start-up to ongoing sources, the project built into routine work and threats paired with responses. A plan that repeats the business case, or assumes the project will last because it works, falls short of the planning aspects. Naming a framework helps, since it gives both structure and a way to score progress each year.
How this D916 Task 2 example is built
The plan opens by restating what the program does and what sustained success would look like in year five. Each domain of the framework has its own heading. Leadership planning names a medical director and an associate director. The stakeholder section explains how referring clinicians will see results. Funding moves from capital to operating budget with a date. Workflow integration adds a screening question to discharge huddles and the electronic record. Training is built into onboarding. Monitoring uses the same measures as the business case so trends can be compared. The adaptation section plans for patient groups often excluded. A threats table and an annual review schedule close the plan, with the framework's scoring tool used at each review.
Where the D916 Task 2 rubric puts the marks
D916 Task 2 aspects are scored competent, approaching competence or not evident. A definition aspect asks whether sustainability is stated in measurable terms. Domain aspects reward planning for leadership, stakeholders, funding, workflow, training, monitoring and adaptation. A threats aspect looks for risks with responses. A review aspect asks for a schedule and a method. Graders check that the plan matches the Task 1 business case in scope and figures, and they notice when funding moves from one-time to recurring sources, which is where many programs fail. Citing the framework and research on program sustainability shows the plan rests on more than good intentions. Clear headings for each domain help.
D916 Task 2 help: what sends it back
Sustainability plans falter in D916 when sustainability is never defined. Say what must still be true in year five. They falter when funding stops at start-up; name the budget line that pays after year one. A program that depends on one champion is fragile, so plan for a successor. Monitoring that uses different measures from the business case breaks the trend line; keep them the same. Last, the plan ignores change. Build in adaptations and a yearly review, because payers, staff and evidence shift, and a plan that cannot adjust will not last. Keep the plan consistent with the figures leaders approved in Task 1, so nothing needs to be explained twice.
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D916 Task 2 questions, answered
Which sustainability framework does the D916 sample use?
A validated clinical sustainability framework with seven domains, including engaged staff and leadership, organizational readiness, workflow integration and monitoring. It organizes the plan and supplies a yearly scoring tool.
Must D916 Task 2 match the business case?
Yes. The program, figures and measures should carry over from Task 1, so the plan sustains the project leaders approved rather than a new one. Changing figures between tasks is a common reason for revision.
Why is funding central to D916 Task 2?
Because many programs end when start-up money runs out. The sample moves ongoing staff costs into the operating budget in year two and reports savings that justify them.
What threats does the D916 sustainability plan address?
Falling referrals, staff turnover, funding pressure and safety events, each paired with a planned response, such as reviewing referral data by service when numbers drop. Each response has an owner.
Where can I find a free D916 Task 2 sample paper?
The complete seven-domain sustainability plan sits above with a note on each part. Send your D916 business case, and the first custom plan built on it is written free of charge.