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Executive Summary

Findings and Recommendations

Scale Up and Spread Activities of the AHRQ Health Care Innovations Exchange

Veronica F. Nieva, Ph.D.
Elaine Swift, Ph.D.
Shannon Fair, RN, MPH

In 2011, the AHRQ Health Care Innovations Exchange undertook several activities on the scale up and spread of health care innovations. These activities generated valuable findings and action recommendations for the emerging field of scale up and spread in general, as well as for the Health Care Innovations Exchange in particular. Findings and recommendations are summarized here.

General Findings

  1. For successful spread of innovations, the gap between the innovator role and the role of the spreader must be addressed.
  2. The inherent value of the innovation is not enough to ensure spread. Innovators have to make the business case for spread, and consider issues such as cost effectiveness, return on investment, and market competitiveness.
  3. For spread efforts to succeed, innovators must engage multiple stakeholders including funders, payers, hospital and health system leaders, health care providers, patients and families.
  4. It is important to assess the Innovation’s readiness for spread and ensure that it is “spread-ready.”
  5. Adopter organizations must be ready to adopt and implement the innovation. Readiness requirements may vary for different innovations.
  6. The innovator’s organization can support or obstruct efforts to spread.
  7. We need to better understand the adoption-related needs of providers for underserved and vulnerable populations.
  8. Implementation and spread is an emerging science and deserves strong support.

General Recommendations

  1. Develop Tools to Support Scale Up and Spread
    • Readiness assessment tools (innovation’s readiness for spread, and adopter organizations’ readiness to implement
    • Market and environment assessment tools
    • Return on investment (ROI) calculators for specific innovations
    • Innovation Selection Tools for Potential Adopters
    • Tools to assess implementation success
  2. Support Training and skill development
    • Mentoring and training in spread skills for innovators.
    • Skill training for change champions in adopter organizations.
    • Learning collaboratives on adoption and uptake.
    • Curricula on innovation and implementation science for medical and nursing schools.
    • Create awareness and demand for innovation among providers for underserved populations.
    • Develop funding and programmatic partnerships with government and private funders interested in supporting SUS.
  3. Support research on scale up and spread
    • Conduct research on topics related to scale up and spread, e.g.
      • What tools and processes are needed to make innovations successful? What incentives do innovators have to innovate, and then to spread their innovations?
      • What types of leadership support are essential for successful implementation of innovation? What are effective ways of obtaining leadership support?
      • How can the costs of innovation be identified, across the variety of organizational units affected, and over time, as innovations mature?
    • Enhance the legitimacy of scholarly work on scale up and spread by addressing publication barriers and establishing a National Center for Research on Scale Up and Spread.

Recommendations for the AHRQ Health Care Innovations Exchange

  1. Enhance the innovation profiles and Web site by adding information related to spread, adoption, implementation and sustainability of innovations.
  2. Serve as a “connector” and matchmaker between innovations and potential adopters, and between innovators and spread organizations.
  3. Facilitate adoption by creating innovation bundles based on clusters of related innovations.
  4. Conduct scale up and spread conferences and create on-line forums for community building and sharing of learnings among those engaged in scale up and spread.
  5. Hold in-person and virtual innovator fishbowls.
  6. Conduct periodic surveys of health care organizations to identify new directions and emerging innovations.