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Taking Best Practices to Scale: Spreading Effective Healthcare Practices & Programs (Text Version)

Slide presentation from the AHRQ 2010 conference.

On September 29, 2010, Wynne E. Norton made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (290 KB).

Slide 1

Slide 1. Taking Best Practices to Scale: Spreading Effective Healthcare Practices and Programs

Taking Best Practices to Scale: Spreading Effective Healthcare Practices & Programs

C. Joseph McCannon, IHI
Brian S. Mittman, VA
Wynne E. Norton, UAB

Denise Dougherty, AHRQ
Michael Harrison, AHRQ

September 29th, 2010
AHRQ Annual Research Meeting

AHRQ #R13HS019422

Slide 2

Slide 2. Objectives


Achieving large-scale implementation requires a new set of research, policy, and practice efforts to understand and address these challenges and facilitate scale-up and spread. This session will (1) describe a series of activities, including a state-of-the-art conference held in July, that the presenters launched to stimulate greater interest and activity in scale-up and spread and (2) engage session attendees in generating ideas for additional activities needed to accelerate scale-up and spread of effective health programs throughout the United States and abroad.

Slide 3

Slide 3. Overview


  1. Introduction & Initial Activities
  2. Overview of Conference
  3. Example of Working Group
  4. Deliverables & Post-conference Activities
  5. Comments from AHRQ
  6. Structured Discussion

Slide 4

Slide 4. Introduction and Initial Activities

Introduction & Initial Activities

Slide 5

Slide 5. Definition of Scale-up/Spread

Definition of Scale-up/Spread

"Deliberate efforts to increase the impact of health service innovations successfully tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting basis."
—Simmons, Fajans, Ghiron, 2007

Slide 6

Slide 6. Why Scale-up/Spread Now? Portfolio of Effective Health Innovations

Why Scale-up/Spread Now?
Portfolio of Effective Health Innovations

  • Demonstrated efficacy and/or effectiveness.
  • Variety of settings, populations, and behaviors.
  • Guidelines, initiatives, simple and complex behavioral interventions, etc.
  • Examples:
    • AHRQ Health Care Innovations Exchange
    • National Registry of Evidence-based Programs & Practices
    • Cancer Control P.L.A.N.E.T.
    • National Guideline Clearinghouse

Slide 7

Slide 7. Why Scale-up/Spread Now? Effective D/I Strategies

Why Scale-up/Spread Now?
Effective D/I Strategies

  • Increasing emphasis on D/I research.
  • Increasing identification of effective or promising D/I strategies.
  • Examples:
    • Technical Assistance (Hamdallah et al., 2006).
    • Organizational change models (Glisson & Schoenwald, 2005).
    • Models, theories, and frameworks (Glasgow et al., 1999; Wandersman et al., 2008).
    • Reviews (Bero et al., 1998; Grimshaw et al., 2006; Grol & Grimshaw, 2003).

Slide 8

Slide 8. Why Scale-up/Spread Now? Need to Plan Ahead

Why Scale-up/Spread Now?
Need to Plan Ahead

  • Scale-up rarely happens automatically.
  • Scaling-up requires significant preparation and planning:
    • Human and financial resources.
    • Political and policy support.
    • Community, organization, and agency collaboration and buy-in.
    • State, regional, and/or national coordination.
  • Issues faced during small-scale studies or pilots are different—and typically less complex—than those faced in large-scale trials or initiatives.

Slide 9

Slide 9. Increasing Focus on Scale-up/Spread

Increasing Focus on Scale-up/Spread

  • Research:
    • Cluster RCTs and PCTs.
    • Embedded research, mixed methods.
    • Frameworks, lessons learned, reviews.
  • Case Studies:
    • Scaling up health service delivery: from pilot innovations to policies and programs (Simmons, Fajans, & Ghiron, 2007).
    • Best Practices in Scaling-up (JSI, 2006).
    • Case Studies in Global Health: Millions Saved (Levine, 2007).
  • Meetings & Organizations:
    • ExpandNet/WHO.
    • USAID: Research and Evaluation Methods for Scaling-up Evidence-based Interventions.

Slide 10

Slide 10. Initial Scale-up/Spread Activities

Initial Scale-up/Spread Activities

  • Think tank, NIH D&I Conference, January 2009
    • Presentations from NIH, Kaiser Permanente, AHRQ, RWJF, VA, CDC, and UCONN and discussion with session attendees.
  • Working dinner meeting, January 2009
    • 30 stakeholder representatives from AHRQ, Commonwealth Fund, CMS, HRSA, IHI, NIH, Harvard, RWJF, John A. Hartford Foundation, Kaiser Permanente, SAMHSA, VA, and the Universities of Michigan, Connecticut, Washington (St. Louis and Seattle).
    • What action is needed by key stakeholder groups to facilitate scale-up/spread?
    • Preliminary recommendations for promoting scale-up/spread.

Slide 11

Slide 11. Initial Scale-up/Spread Activities

Initial Scale-up/Spread Activities

  • Health Funders Bending the Curve: Accelerating the Journey from Evidence to Adoption, Donaghue Foundation & RWJF, June 2009.
    • Discuss opportunities and challenges with adoption of research findings so funds can have greatest impact.
    • Attendees included AHRQ, CA HealthCare Foundation, Commonwealth Fund, Grantmakers in Health, VA, Kellogg Foundation, John A. Hartford Foundation.
  • Commissioned Study, 2009-2010
    • Funded by Donaghue Foundation.
    • Semi-structured interviews with 10 exemplary programs.
    • Barriers, facilitators, and initial recommendations for scaling-up health promotion/disease prevention interventions.

Slide 12

Slide 12. Next Steps

Next Steps

  • Need for larger, more comprehensive meeting on scale-up/spread.
  • Include researchers, practitioners and policymakers.
  • Public health and health care.
  • State-of-the-Art conference...

Slide 13

Slide 13. Scale-up/Spread Conference

Scale-up/Spread Conference

Slide 14

Slide 14. A Conference to Advance the Science and Practice of Scale-up/Spread of Effective Health Programs

A Conference to Advance the Science & Practice of Scale-up/Spread of Effective Health Programs

  • July 6-8th, 2010 in Washington, D.C.
  • Organizers: Joe McCannon (IHI), Brian Mittman (VA), and Wynne Norton (UAB).
  • Funders: AHRQ, Commonwealth Fund, VA, Donaghue Foundation, and John A. Hartford Foundation.
  • Planning Committee Members: IHI, NIMH, VA, CMS, Karolinska, Gates Foundation, AHRQ, Commonwealth Fund, URC, and Univ. Wisconsin.

Slide 15

Slide 15. Attendees


  • IHI
  • UAB
  • VA
  • RWJF
  • AHRQ
  • CMS
  • Gates Foundation
  • Kaiser Permanente
  • CDC
  • U.S. Dept of Education
  • NIMH
  • CIHR
  • Stanford
  • USCF
  • UNC
  • Johns Hopkins
  • Harvard
  • Yale
  • Georgetown
  • AHA (HRET)
  • Karolinska Institute
  • ExpandNet
  • Blue Cross Blue Shield
  • John A. Harford Foundation
  • Health Partners
  • Donaghue Foundation

Slide 16

Slide 16. Conference Aims

Conference Aims

  1. To review existing knowledge and current practices related to the scale-up and spread of effective practice in health care and public health.
  2. To identify key challenges and gaps in current research, policy, and practice related to scale-up and spread in health care and public health.
  3. To develop and disseminate a detailed agenda outlining critical research, policy, and practice initiatives on these topics for the next five to seven years.
  4. To launch specific activities to operationalize this agenda, creating a plan of action to prioritize research, policy, and practice activity and initiating powerful demonstrations of regional, national, and international scale-up in health care and public health.

Slide 17

Slide 17. Conference Format

Conference Format

  • Modeled after VA State-of-the-Art meetings.
  • Brief introduction and background.
  • Small working groups, product-oriented.
  • Evening session speakers:
    • Huggy Rao (Stanford)
    • Nancy Dixon (GW)
    • Rashad Massoud (URC)
    • Russ Glasgow (Kaiser)
    • Chris Goeschel (Johns Hopkins)
    • Anne-Marie Audet (Commonwealth)

Slide 18

Slide 18. Conference Content

Conference Content

  • General meeting overview, logistics, worksheets.
  • Background papers and case studies.
  • Working bibliography.
  • Database of research and practice activities.
  • Commissioned papers:
    • Health care (Perla et al., IHI)
    • Public health (Edwards, CIHR)
    • International (Øvretveit , Karolinska)
    • General framework (McCannon, IHI)

Slide 19

Slide 19. Working Groups

Working Groups

Working Group Charge:

  • Envision the ideal system for scale-up and spread
  • Identify gaps between current state and future state
  • Make detailed recommendations for action

Working Group Chairs:

  • Health Care Research: Denise Dougherty, AHRQ
  • Policy: Maulik Joshi, HRET/AHA
  • Public Health Research: Todd Molfenter, Univ. Wisconsin
  • Health Care Practice: Marie Schall, IHI
  • Public Health Practice: Jürgen Unützer, Univ. Washington

Slide 20

Slide 20. Recommendations


  1. Create more thoughtful incentives for scale-up/spread (e.g., funding, recognition, career advancement).
  2. Stimulate donor-researcher-funder coordination in order to coordinate goals, priorities and activities.
  3. Enhance "pull" systems of change to complement "push" efforts.
  4. Develop environments for learning and sharing on scale-up:
    • Knowledge exchanges, webinars, curricula.

Slide 21

Slide 21. Recommendations


  1. Develop tools and resources on executing scale-up and spread:
    • How-to guides (what, when, and how to spread for different types of interventions).
    • Case studies.
    • Taxonomies.
    • Technologies.
  2. Develop and catalogue expanded research methods and improved data collection systems.

Slide 22

Slide 22. Example of Conference Working Group

Example of Conference Working Group

Health Care Research Working Group
Chair: Denise Dougherty, AHRQ

Slide 23

Slide 23. Deliverables and Post-Conference Activities

Deliverables & Post-Conference Activities

Slide 24

Slide 24. Short-Term Deliverables

Short-Term Deliverables

  • VA-sponsored scale-up/spread webinar series.
  • Peer-reviewed publications.
  • Detailed agenda for research and practice, including "performance challenges" (meeting proceedings).
  • Update and expand scale-up/spread databases and resource listings (e.g., tools, literature, projects/programs).
  • Presentations at targeted meetings.
  • Interactive Scale-up/Spread Listserv.

Slide 25

Slide 25. Potential Longer-Term Actions

Potential Longer-Term Actions

  • Active contribution to major scale-up projects.
  • Advocacy: Active connection to donors, policymakers, etc.
  • Durable learning network: Case studies, information exchanges, community of practice.
  • Annual gathering.
  • Course development.
  • Tool development.

Slide 26

Slide 26. Comments from AHRQ Attendees

Comments from AHRQ Attendees

Michael Harrison, PhD
Denise Dougherty, PhD

Slide 27

Slide 27. Thank you!

Thank you!

Scale-up/Spread Blog:

Current as of December 2010
Internet Citation: Taking Best Practices to Scale: Spreading Effective Healthcare Practices & Programs (Text Version). December 2010. Agency for Healthcare Research and Quality, Rockville, MD.


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