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Table 3 Key findings from grey literature publications

From: The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review

Authors/title/method Research question/aim Main process(es) Definitions Mechanisms involved in spread/scale-up/sustainability Factors that facilitate or impede spread/scale-up/sustainability
Massoud et al., Framework for spread: From local improvements to system-wide change (United States of America) [72] Provide a snapshot of the Institute for Healthcare Improvement’s latest thinking and work on spread Spread None mentioned Preparing for spread involves acknowledgement by leadership that the improvement project is a key strategic initiative of the organisation, and designation of both executive sponsorship and day-to-day leadership. The existence of successful sites that are the source of the specific ideas to be spread, as well as evidence that the ideas result in the desired outcomes are important
Establishing an aim for spread involves identifying the target population, specific goals and improvements, and a time frame for the effort
Developing, executing and refining a spread plan includes communication methods and channels to reach and engage the target population, a measurement system to assess progress in meeting the spread aims, and anticipation of actions needed to embed the changes into the organisation’s operational systems
Characteristics of the innovation
Willingness or ability of those making the adoption to try the new ideas
Characteristics of the culture and infrastructure of the organisation to support change
Clinical Excellence Commission (2008) Enhancing project spread and sustainability: a companion to the ‘easy guide to clinical practice improvement’ (Australia) [73]
The Spread and Sustainability Wheel
Provide helpful tips and practical advice to clinicians and health managers on how to improve and asses the spread and sustainability of clinical practice improvement projects Spread
Spread and sustainability: ensure that recognised improvements are maintained beyond the life of the project, and are extended to other areas of healthcare that would also benefit None mentioned Nature of initiative
Ownership of initiative: leadership and support at senior level
Readiness for improvement
Effective relationships
Integration into practice
Evidence of improvements
Local context
Staff engagement
Processes of implementation
Dedicated resources
People with influence
Lomas, Formalised informality: an action plan to spread proven health innovations (New Zealand) [74]
Summary of the Action Plan to Improve Innovation Spread
Identify gaps and highlight the actions and actors needed to address these gaps for improved spread of innovation in New Zealand’s health sector Spread None mentioned Coordinating, supporting and integrating the three phases of the innovation chain: production/evaluation, dissemination and adoption
Interacting interorganisationally is more effective to spread innovations than focussing on structures
Dedicated resources for innovation exploration and development
Focused and coordinated evaluation capacity to identify which innovations are worthwhile
Commitment from senior leadership
Alignment with policy and political priorities
Attention to potential adopters’ needs and their balance of costs and benefits
Training programmes on innovation-driven change management for managers and clinicians
Time set aside specifically for reflection and experimentation by the workforce
Slack resources for new projects
Relational capital, networks and face-to-face exchanges between stakeholders: Investment in social interaction, not just structures and technology
Historical, cultural and economic (dis)incentives for interorganisational collaboration
Porous boundaries between the ideas and action communities
Boundary-crossing intra- and interorganisational interaction, reflective time: Incentives and networks for ongoing interaction between innovators, evaluators and implementers
Targeted persuasive communication, tailored to different audiences
Differentiated and decentralised decision-making
Specialised focus of professional knowledge in a teamwork environment
Because innovations are characterised by novelty and problem orientation, a barrier to spread is their challenge to the status quo
Health Quality Ontario, Spread Primer (Canada) [7] Spread in the quality improvement framework Spread Spread: the active dissemination of best practices and knowledge about interventions, and the implementation of interventions in every applicable care setting
Improvement knowledge generated anywhere in the system becomes common knowledge across the system, leading to improvement action
Developing strategies for spreading improvements from the beginning of the improvement project and start small
Sharing accountability for spread and empowering others to lead spread builds commitment to common goals as well as the infrastructure to sustain change
Ensuring that improvements and the renewed energy and satisfaction that innovations generate reach all parts of the organisation
Using a variety of approaches makes it easy for staff to be receptive and adopt change
Nature of the change induced by the innovation
Organisational readiness for change
Awareness of change concepts and ideas
Applicability of potential changes to new environments
Belief that change ideas will result in improvement
Taking action to adopt the change
Sense of urgency and understanding of unmet needs
Team collaboration in designing spread plan
Regular review of data on defects and performance
Quality Improvement Hub, The spread and sustainability of quality improvement in healthcare (United Kingdom) [75]
Literature review
Increase understanding of the 10 key factors underpinning successful spread and sustainability of quality improvement in NHS Scotland Spread
Spread: when best practice is disseminated consistently and reliably across a whole system and involves the implementation of proven interventions in each applicable care setting
Sustainability: when new ways of working and improved outcomes become the norm
Disseminating why the change is needed
Ensuring that those involved have a desire to support and participate in the change as well as knowledge of how to bring about the change
Implementing new skills and behaviours and redesigning processes to sustain the change
Clarity of benefit
Real time data to drive improvement
Human factors: understanding of why common errors are happening and then redesigning, with steps to prevent the errors
Culture: understand the role of culture on behaviours and ability to deliver improvements
Change management: support for people to understand the problem a change is attempting to fix and involve them in designing and testing the solutions
Leadership combining technical quality improvement skills with effective interpersonal and relational skills
Accessibility, use and sharing of knowledge and resources
Engagement of everyone with a vested interest, across all levels and roles, in the improvement team
Evaluation to understand how activities, outputs and outcomes link and ensure learning and feedback loops are in place
Empowerment of staff, patients and carers
Healthcare Improvement Scotland, Guide on spread and sustainability (United Kingdom) [76]
Literature review
Summarise existing resources and key pieces of research around spread and sustainability
Propose spread and sustainability framework
Spread: the process of communicating new ideas or innovations outside the original system
Sustainability: when new ways of working and improved outcomes become the norm
Increasing awareness of the need for greater attention and activity in scale-up, including research, practice and policy activity
Expand capacity for scale-up policy, practice and research
Facilitating information exchange, collaboration and use of existing knowledge
Developing and applying new approaches for evaluation
Attributes of innovation
Attributes of adopters
Internal and external contextual factors
System readiness
Evaluation, adaptation, embeddedness and institutionalisation of innovation
What Works Scotland, Evidence review: scaling-up innovations (United Kingdom) [77] How can small scale innovation be effectively scaled up to create large scale transformational change?
Provide actionable messages on how to scale-up healthcare innovations
Scale-up Scale-up: Delivering or enacting an innovation in a way that increases the number of people benefiting from it while ensuring the original design and measures are maintained There is no agreement on which approaches to use or on what constitutes success of scaling-up healthcare innovations
Considering both ‘hard’ components like metrics, and ‘soft’ components like sociocultural factors when thinking about scalability
Scaling is emotionally, mentally and physically demanding
Influencing and advocating for innovation enable buy-in to the innovation and scaling process, as opposed to position and authority
Collaborating and networking play pivotal roles in spreading innovations by increasing buy-in from stakeholders and increasing the sharing of resources, knowledge and experience
Planning for spread while considering that the non-linear nature of spread means that not all dynamics and consequences of an innovation can be planned for in advance
Implementing an innovation should use sufficient flexibility while retaining fidelity to the core components
Having multiple and creative ways to assess and evaluate the adoption and implementation of an innovation helps to embed it within the larger system
Composing teams to scale innovations should be considered carefully to meet needs and team composition should be reviewed regularly to ensure required skills and competencies
Adequate time and planning
Adaptation of strategy to the complexity of the innovation
Agreement between stakeholders regarding the intentions and goals of the scale-up process
Infrastructure and administrative and technical support
Distributed leadership across levels and partners: cross-scale interplay and sharing of power through combining top-down and bottom-up approaches
Size and complexity of the innovation and scaling goals
Collaboration and networking
The innovation narrative
Encouragement for change
Facility of information exchange, collaboration and use of existing knowledge
NHS Institute for Innovation and Improvement, Sustainability model and guide (United Kingdom) [78]
Action research
The NHS Sustainability Model and Guide were developed for use by individuals and teams involved in local improvement initiatives Sustainability Sustainability: when new ways of working and improved outcomes become the norm Using the NHS Sustainability Model and Guide (scoring sheets) to support and monitor sustainability of healthcare innovations Innovation fit with goals and structure
Progress monitoring
Credibility of evidence
Benefits beyond helping patients
Staff training, involvement and attitudes
Leadership: senior and clinical
Organisational infrastructure
Gabriel, Making it big: strategies for scaling social innovations, Nesta (United Kingdom) [79]
Stages in developing a scaling strategy
How can social innovators spread their innovations?
Help social innovators think through their scaling strategies, reflect on the benefits and challenges of different options, and show how others have tackled these issues
Scale-up Scale-up: increasing the number of people who benefit from a social innovation Clarifying social, organisational and personal goals for scaling
Establishing what to scale up
Choosing a route to scale-up (influence and advise, build a delivery network, form strategic partnerships, grow an organisation to deliver) and gearing up to deliver a scaling strategy
None mentioned