Overview of Post Conference Activities

The July 2010 State-of-the-Art Conference to Advance the State of the Science and Practice on Scale-up and Spread of Effective Health Programs generated a set of recommendations for advancing the spread and scale up of innovative ideas and practices in health care and public health. Conference recommendations included:
1.Increase awareness of the need for greater attention and activity in scale-up and spread, including research, practice, and policy activity.
2.Facilitate better information exchange, collaboration and use of existing knowledge regarding scale-up and spread.
3.Develop, evaluate and refine innovative scale-up and spread methods, including novel incentives and “pull” strategies.
4.Develop and apply new approaches for evaluation of scale-up and spread.
5.Expand capacity for scale-up and spread policy, practice and research.

Conference attendees generally agreed that the specific recommendations produced at the conclusion of the conference represented a strong start but did not comprise a comprehensive, actionable and compelling set required to provide a strong foundation for future activity. With continued grant support from AHRQ, we are pleased to announce a fall 2011 project to “virtually” reconvene conference attendees (and other key stakeholders) to refine and elaborate the conference recommendations and to develop specific plans for operationalizing key recommendations. Our ongoing discussions with representatives from CMS, VA, CDC and other federal, state and private organizations have indicated the timeliness of these issues and the clear need for additional guidance regarding scale-up and spread.

The fall effort includes two parts:
1. A web-based survey asking you to review, refine and prioritize the conference-generated recommendations and to offer specific suggestions for actions needed to operationalize each recommendation.
2. A conference call / on-line discussion to further discuss and refine the expanded set of recommendations, leading to their formal publication and dissemination.

We think this is an exciting opportunity to provide meaningful input and guidance for important, time-sensitive policy and practice activities in health care and public health. If you would like more information about the post-Conference activities please contact Deborah Jenkins (Deborah.Jenkins@va.gov).

Scale-up/Spread Activities Conducted by the AHRQ Health Care Innovations Exchange

The AHRQ Health Care Innovations Exchange aims to improve quality,
reduce disparities, and enhance efficiency by fostering the adoption of
innovations in health care delivery. The Innovations Exchange includes
an adopter-oriented Web site (www.innovations.ahrq.gov) with a central
repository of over 475 searchable innovations and 1,500 quality tools.
The site offers guidance to support innovation uptake, including
evidence ratings, practical adoption considerations, comments, and
innovator contact information.

The Innovations Exchange is very interested in promoting the
sustainability and spread of promising health care innovations and is
actively exploring avenues to help advance this area and support
innovators in addressing challenges to spread. Recent and upcoming
activities of the Innovations Exchange include:

1. Sponsoring a meeting for health care innovators who have contributed
innovations to the Innovations Exchange. The meeting, which took place
one day prior to the AHRQ Annual Conference this past week, engaged
innovators in discussing innovator roles, challenges, needs, and rewards
related to the spread of their innovations.

2. Developing brief articles and perspectives for the Innovations
Exchange Web site discussing the spread of innovations. Innovations
Exchange staff will contribute some of these pieces by interviewing
selected participants in the recent Conference to Advance the State of
the Science and Practice on Scale-up and Spread of Effective Health
Programs.

3. Convening a virtual roundtable with a group of participants from the
Conference to solicit discussion on how the Innovations Exchange can
help foster spread of health care innovations.

Please contact the Innovations Exchange (info@innovations.ahrq.gov) to
learn more about these activities. We encourage other stakeholders to
contribute to these and other activities designed to promote greater
interest and activity in scale-up and spread.

News

I wanted to share with you all that, after almost nine terrific years of work in association with the Institute for Healthcare Improvement, I will be taking a new position at the Centers for Medicare & Medicaid Services. I will be based in Washington, DC.
Given my passion for improvement and dissemination, this seems like a terrific opportunity, and it's one I'm eager to take. Having said that, I will need to step down from my position as chair of the conference and our learning community. Marie Schall, who you all now know from her role as a working group chair at the conference, will take over as the point person from IHI, joining the conference co-chairs, Brian Mittman and Wynne Norton.
Happily, they will shortly initiate the VA-sponsored webinar series which should help sustain the momentum from our gathering (more information to come on that shortly). I know I speak for Brian, Wynne and Marie when I say that our shared hope is for this group to continue to come together regularly to build will and tools for the field, and to actively study and support ongoing scale-up efforts.
I am still awaiting my ethics orientation, at which point I will better understand the boundaries of my future involvement, but I fully intend to stay as involved with the group as possible.
Thank you very much for you ongoing involvement with this important work.
All the best,
Joe McCannon

Post-conference WebEx Recording

If you were not able to join the Scale Up Post-conference WebEx session yesterday, please feel free to listen to the recording of the call here: https://ihi.webex.com/ihi/lsr.php?AT=pb&SP=TC&rID=53361357&rKey=eabf0e46b42850fd&act=pb. When you click on the link, you may be directed to download the WebEx player. Please follow the instructions when prompted. The session is approximately an hour and fifteen minutes long. Please fast forward to 00:04:45, which is when the formal session begins. If you have any questions about the session, or the conference in general, please email Joe McCannon at jmccannon@ihi.org or myself, at ldegennaro@ihi.org.

 

Thank you,

 

Lindsay DeGennaro

Dissemination & Implementation in Health Listserv

Below is information about the Dissemination & Implementation in Health Listserv, a monthly distribution of information on late-breaking research, practice, and policy activities in the broad area of dissemination and implementation in health care and public health, including publications, reports, conferences, meetings, program announcements, funding opportunities, and other various proceedings.

The listserv is purposely broad in membership and scope, and encompasses the areas relevant to dissemination and implementation in health care and public health, including: scale-up/spread, capacity building, knowledge translation, quality improvement, research-to-practice, diffusion, knowledge transfer and exchange, adoption, complex interventions, implementation strategies, action research, translational research, and other related terms and sub-disciplines. If you are interested in joining this listserv, send an email to listserv@listserv.uab.edu with the body of the message stating: Subscribe D-I-Health your name. You should receive a message from the listserv with instructions for how to complete your subscription. Archives for the listserv can be found at http://listserv.uab.edu/D-I-Health.html. Postings are also available on the Center for Health Dissemination and Implementation Research website (www.research-practice.org). Please feel free to circulate this information to interested colleagues.


We hope that this is one of many ways that we can continue to communicate with one another and grow this exciting field.


Please contact me with any questions, comments, or suggestions.


Wynne Norton
wynne.norton@gmail.com

A Few Brief Thoughts on Day Three

First and foremost, I'd like to thank everyone who participated in the scale-up/spread conference during the past few days, including planning committee members, funding agencies, working group leaders, paper authors, recorders, logistics coordinators, and the impressive, diverse, and wonderful group of attendees. 

Second, I want to highlight three sample ideas that I think resonated with group members, as they were reflected in several of the recommendation statements provided during the report-out sessions toward the end of today:

1. We need to create a mechanism for sharing the rich set of stories that we have on scale-up/spread, which would include descriptions of both our successes and our failures. 

2. We need to re-conceptualize traditional forms of measurement and monitoring, from a perspective that is predominantly project-specific or time-limited to one that views data as a continuous, ongoing opportunity to learn about what is working, what isn't working, and what can still be improved.

3. We need to take advantage of the opportunity to describe, assess and/or test different strategies (or combination of strategies) of scale-up/spread as they occur in everyday settings where "pull" activity is already in place. Researchers should be embedded in such projects to help grow an evidence-base in scale-up/spread methodology. 

Finally, I would like to reiterate the fact that we really view this meeting as the beginning of a series of activities, collaborations, and products that will occur over the weeks, months, and years to come. We look forward to your suggestions, input, and contributions as we work collectively to advance this exciting field.

Wynne Norton 

Six Interesting Ideas from Day Two

After a review of the conference's helpful commissioned papers on scale-up and spread in health care, public health and international health settings, the meeting turned to a visioning exercise where work groups tried to (a) imagine the attributes of a better system for spreading effective practice, and (b) identify "gaps" or areas for improvement. Though I didn't have the benefit of being in all groups at all times, here are some common themes and great ideas to emerge in the conversation:

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

A Great Opening Evening (Day One)

We were very privileged this evening to hear from Dr. Huggy Rao (Stanford; author of Market Rebels) and Dr. Nancy Dixon (George Washington; author of Common Knowledge) to set the scene for this conference.

Nancy took us behind the scenes of the US Army's powerful systems for knowledge management, and Huggy shared with us a series of stories from the US and abroad (including memorable examples from the subway system in New Delhi and 7-11 stores in Japan) , which highlighted ways that behaviors and beliefs interact in order to stimulate change and adoption. Both Nancy and Huggy emphasized the power of "pull" strategies for letting the empowered customer or adopter drive change, and both cautioned against pushing out too much information and creating more of a "cognitive load" on already burdened recipients of information.

As hoped, the conversation was stimulating and disrupted our normal patterns of thinking.

Huggy and Nancy have set a lovely tone for the meeting. We now look forward to tapping into all of the collected knowledge held by the conference's diverse group of attendees. Tune into tomorrow as we really begin to roll up our sleeves...

Joe McCannon

Hash Tag/Your Feedback

Several have asked about a Twitter hash tag for this week's meeting...I've just used #susconf (for scale-up and spread conference) and would invite others to do the same.

Also, several individuals have asked if they can offer updates to the conference documents posted here in the right hand column. Again, we would welcome that. And while all of the documents prepared for this conference can be viewed as works-in-progress (insofar as we'd like to add to continually deepen our learning based on your expertise) we'd especially like to invite your feedback on the bibliography and the database of projects and organizations working on scale-up and spread. Each of these documents offers the name and contact info for someone you can email directly to offer suggestions and additions.

Thanks!

Joe McCannon

Introductory WebEx Recording (Starts at 18-minute Mark) and Preparatory Activity

For those who were unable to attend Friday's introductory WebEx session for the conference, you can tune in here for a recording:
https://ihi.webex.com/ihi/lsr.php?AT=pb&SP=TC&rID=52907387&rKey=1a70e3cdc92c7c8d&act=pb
You might need to take two minutes to download the WebEx player (instructions will pop up) if you have not done so already. Please note that you should fast forward to the 18-minute mark as that is when the formal call begins (otherwise you will just hear patches of conversation and long silences as we readied for the session).
For those who are attending the meeting, please let us know if you have any questions and please try to carry out the core preparatory tasks we outline in the WebEx: Reading the commissioned papers, including the "meeting framing" paper; completing the preparatory worksheet; and scanning the case studies.
For those unable to attend, you should still find the WebEx call informational and, again, we hope you'll continue to tune into this site before, during and after the meeting.
Please feel free to reach out to me with any questions (jmccannon@ihi.org).
Thanks.
Joe McCannon

June 25 Introductory Call

Once again, we’re very excited for our upcoming Conference to Advance the State of the Science and Practice on Scale-up and Spread of Effective Health Programs. The meeting is shaping up very well, and the attendee list is outstanding. We’re really looking forward to seeing those who can join us. This is a reminder – for attendees and non-attendees alike - of the WebEx session we are planning from 11:30am-12:30pm eastern US time on June 25th. This will introduce the meeting in more detail, describe its agenda and link you to materials and resources we’ve collected in advance. This session will also explain the brief assignments we have for you in advance of the meeting, which we hope will make the meeting itself much more enjoyable and effective.

Full connection information is as follows:

Topic: Scale-Up Conference Pre-Meeting Call
Date: Friday, June 25, 2010
Time: 11:30 am, Eastern Daylight Time (New York, GMT-04:00)
Session number: 354 202 488

Web link: Go to https://ihi.webex.com/trainingcenter - the meeting link will be there (if for any reason you have trouble finding the link to the session, you can use the search function underneath the “Live Sessions” title and type in “Scale-Up Conference”).

Call-in toll-free number (US/Canada):1-866-469-3239
Call-in toll number (US/Canada):1-650-429-3300
Global call-in numbers: https://ihi.webex.com/ihi/globalcallin.php?serviceType=TC&ED=135696222&tollFree=1

We very much hope you can be with us.

Joe McCannon