Highlights of learning about scale up and spread
“Ultimately, we’re all focused on a single specific challenge. How do we shorten
the time between development of innovations and their implementation?” –
Carolyn Clancy, Director, AHRQ
In the NIH panel and Round Table on Scale Up & Spread, innovators, researchers,
and other participants drew on their work to offer observations, guidance, and lessons
learned on topics including the role of the innovator, the process of scale up and
spread, and the role of adopter organizations. The following summarizes the highlights
of what we have learned about scale up and spread with illustrative quotes from
participants.
The role of the innovator is different from the role of the spreader
“Interestingly, each of the innovators shied away from anything that was suggestive
of a marketing plan, each stating in their own way that the idea of actively promoting
their innovation made them uncomfortable.” -- Lisa Suennen, Psilos Group
Managers, LLC
Innovators are often dedicated clinicians, academics, or health care professionals
with an altruistic interest in improving health care service delivery. Joseph Skelton,
developer of an innovation to reduce childhood obesity, described his motivation
to address the issue of “how can we treat kids and their families who are struggling
with weight problems and do a better job at it every year.” Linda Wick, manager
of an innovation to treat chronic heart failure, described her goal as helping patients
and their families manage the demands of a serious illness. David Dorr, who developed
an innovation on primary care, said that he wants “to improve the care for the most
at-risk people in the practice, people with multiple chronic diseases, especially
older adults.”
Several Fishbowl Panelists noted that spread, in contrast, is an entrepreneurial
task that involves engagement with actors who are often focused on economic issues.
Business consultant Steve Shields noted that “doing something because it’s the right
thing to do and having a passion about it is what creates the success. But it’s
not enough for the people that need to help you.” Lisa Suennen explained that “if
you want to propagate it in other parts of the community, then you need to find
and engage and co-opt a payer into figuring out why this is good for their business.”
The work of scale up and spread takes the innovator into the unfamiliar—and possibly
uncomfortable—world of challenges such as analyzing and outperforming the competition,
developing a business case and marketing plan, courting partners and investors,
and forming a national advisory board. Innovations consultant Paul Plsek observed
that “typical innovators in health care don't even know the world that they've stepped
into. There's a whole new language.” As health care innovator Linda Wick explained,
“I need people to give me feedback that are out there in the business world and
not the provider world.”
To make the transition to the more entrepreneurial role of spread agent, innovators
will need to develop spread-related knowledge and skills. Although it may be neither
practical nor possible for innovators to acquire proficiency in the many areas required
to comprehensively promote an innovation (e.g. finance, marketing), they may be
interested in gaining a working knowledge of critical elements such as estimating
a return on investment (ROI), developing a business case, understanding marketing
techniques, and assembling a team to plan and implement an SUS strategy.
Fishbowl panelists also observed that successful entrepreneurship requires more
than just mastery of business issues. It also requires strong leadership qualities.
As Lisa Suennen commented, “A good idea with a great leader always beats a great
idea with a good leader. Always. Every time.” Steve Shield also noted the large
role that “the force and the charisma and the mental clarity” of the leader played.
He observed that innovators may decide to lead the spread process or to turn that
role over to someone else.
