Ten simple rules for achieving sustainable Quality Improvement in nursing practice.

The implementation of sustainable quality improvement (QI) initiatives remains a significant challenge in nursing practice. This paper presents an evidence-based guide comprising ten systematic steps designed to facilitate the development and maintenance of sustainable QI projects within healthcare settings. The guide integrates established methodological approaches, including the Plan-Do-Study-Act cycle, with practice-oriented strategies for stakeholder engagement and resource optimization. This structured approach addresses key elements of sustainable QI through four core components: preliminary capability assessment, project-specific sustainability planning, systematic implementation and outcome measurement. The methodology draws from current healthcare guidelines and recent research across multiple healthcare settings, validated through pilot implementations in diverse clinical environments. The findings demonstrate that sustainable QI initiatives require systematic planning, continuous stakeholder engagement, and incremental implementation strategies. This evidence based guide provides healthcare practitioners practical, actionable steps for implementing and maintaining quality improvements in clinical practice, offering a bridge between theoretical QI models and real-world application.