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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.