1. We need to redesign incentives (e.g., payment, recognition, career advancement) for innovators and researchers that drive them to scale-up and deepen their skills in implementation and spread.
2. There is work to be done on raising awareness about the importance of change management and scale up that has to occur simultaneous to actual change management efforts (i.e., we need to create a ready substrate of the "interested, willing and capable").
3. There is an important distinction to be made between efforts to scale up a particular practice and multi-disciplinary efforts to improve health for large populations (i.e., differences in the motivations, interventions and mechanisms for these different types of change).
4. There is chronic underuse and under-testing of innovative practices, technologies and methods, particularly from other fields, and there is a need for "facilitated evolution" in order to accelerate learning and adoption -- creating networks of distributed innovation among all actors in a given system, region or population.
5. We need to create some kind of shared system for setting health care and public health priorities, based upon some calculus (acuity, volume, etc.).
6. We new forms of evaluation that yield learning during the scale-up process, as well as reliable studies of project performance at the conclusion of a given effort.
Over dinner, we also heard from Anne-Marie Audet, Rashad Massoud, Russ Glasgow and Chris Goeschel, offering perspective on ongoing efforts at to spread effective practices inside and outside of the US. Their stories and outcomes - which we'll include in the conference notes - were very compelling, demonstrating innovative models of spread and breakthroughs in mobilizing energy and activity at the front lines of care. Once again, we'll benefit from these stories and insights as we re-engage tomorrow.
Joe McCannon
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