A tool-kit for the evaluation of sustainability processes and
sustainability levels of public health programs and projects



Activities: An activity is defined as the understandable behavior of individuals with respect to the behavior of others. Programs prescribe the activities required to achieve a set of objectives that direct the behavior of people involved. In turn, these activities consist of tasks to be completed while drawing on financial, human and material resources.

Adaptation: The notion of adaptation refers to a modification or adjustment aiming at coherence and harmony. Routinized activities are adapted to programs/projects’ and organizations’ contexts or environments. Adaptation is one of the four characteristics of organizational routines.

Event (e.g. actions taken): Events are relevant observation units for assessing processes. Events are defined as elements in sequences (ordered samples of phenomena, order being usually temporal). Events and their consequences may contribute to explaining organizational processes. Events are distinguished by what is set off in time by a before and an after, and there are multiple types of events (mergers, decision-makings, meetings, etc.).

Evaluation: Evaluation is a judgement process that takes a critical approach and utilizes systematic data collection in order to make decisions.

Indicator: An indicator is a significant parameter used to measure outcomes, resource utilization, works progression status, or context.

Institutional standards: Institutional standards are defined as social norms established by state-level authorities (professional corporations or public administration). Neo-institutionalists emphasize the legitimacy of institutional standards upon which organizations are based over power and coercion. These standards are public and exist legally for the social good. Institutional standards directly constrain organizations or people. State-level measures, principles, policies or regulations that constrain organizations and people make institutional standards operational. Examples of institutional standards include federal, state level, county level, and municipal government rules and policies, as well as professional guidelines and accreditation standards that might be set by universities, hospitals, or school districts.

Memory: Memories refer to shared interpretations of past experiences that influence present activities. Memory requires stable resources and includes three major components: social networks, paper-based resources, and electronic resources. Memory is one of the four characteristics of organizational routines.

Organizational routines: Organizational routines are defined in terms of memory, adaptation, values, and rules. A routine is a typical procedural operation. Routines are integrated in organizations like the memory of actions or procedures shared by the actors. Routines are adapted to suit their contexts. Routines reflect the values, beliefs, codes, or cultures by means of symbols, rituals, and language. Routines adhere to rules that govern action and decision-making such as manuals of procedure, rules of information transmission, or plans.

Program/project: A program/project is a coherent, organized and structured set of objectives, activities and resources (human, financial and material), which are carried out by people involved for achieving the objectives. It is justified on the basis of needs of individuals, communities or a society. It is usually controlled by one or many people who are responsible for the quality of its design and operation.

Program/project implementation: A program/project’s implementation consists of a mobilization of resources to set up activities to reach an objective.

Routinized program/project: A routinized program/project is defined by the presence of routinized activities, i.e. activities presenting the four characteristics of organizational routines: memory, adaptation, values, and rules. To be considered routinized, at least one activity stemming from a program/project must possess all four of these characteristics. Routinization is considered to be the first sustainability process, while standardization is considered to be the second.

Rules: Routinized activities follow rules that regulate decision making and action. Rules are one of the four characteristics of organizational routines.

Sustainability level: The notion of sustainability level refers to a ‘snapshot’ of the sustainability process at a certain moment in time. The presence of organizational routines makes it possible to evaluate the sustainability level of a program. The four characteristics of organizational routines are: memory, adaptation, values, and rules.

Sustainability process: The notion of sustainability process refers to the processes that allow for the continuation of effects and activities relating to programs and projects. This process begins with the first events that outline a program or a project, i.e. their planning and implementation.

Standardized program/project: A standardized program/project is defined by the presence of routinized activities in accordance with public policy. Program/project standardization is considered to be the second sustainability process. Standardized programs/projects are even more durable than routinized programs/projects.

Values: Values and collective beliefs are manifested through cultural artefacts such as codes, symbols, rituals, or jargon. The formulation of objectives is also based on values and collective beliefs. Values are one of the four characteristics of organizational routines.