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Learning to forget: deimplementation and the science of sustainability in healthcare

Quality and Safety in Health Care Journal -

What if the biggest threat to sustainable improvement in healthcare is not failing to learn—but failing to forget?

Sustainability is not static maintenance; it is evolution. Health systems that can adapt, discard and relearn, retaining what matters and deliberately forgetting what no longer serves patients, can sustain high-value care and continually move beyond low-value practices.

When learning is not enough: why health systems must learn to forget

Healthcare prides itself on being a learning system. We collect data, consider the context, analyse outcomes and iterate improvement cycles. Yet, true sustainability—the ability to embed and maintain improvement over time—requires more than learning: it demands deliberate unlearning. Outdated order sets, decision rules and routines have the potential to shape care long after evidence has evolved.1 A paradox of improvement is that systems cannot sustain what is new until they have let go of what is old....

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