Readiness diagnostic tools for spread, scaling up, dissemination

So how do you know whether your organisation is ready to embark on a program to adopt existing good ideas / evidence in a systematic way?

As in previous posts, most of the answer to this question is a no-brainer - you know the answers already (see previous posts).  However, sometimes it's nice to have a checklist or set of tools to help you check whether what you know about is actually in place.

There are many general tools / checklists available which check whether your team or organisation is ready to do something different.  Most of these assess the culture of the group. The disadvantage here, which is why I suspect many people avoid these types of tools, is if you find out that your culture is not ready, many people lack the patience to go through the necessary cultural change - or they just don't have the time for this "pre-work".

Generic tools can be useful for learning about your organisation though they can be a good (and time-wasting) displacement activity by organisations.

The best types of diagnostic tools are those which are specific to the change in hand.  Specific means they are designed around and for the type of change proposed.

1. One of the best examples I know of specific diagnostic tools come from, the US National Council on Aging. For their Chronic Disease, Falls and Depression scale up plans they have open access tools which can be completed online or you can download the PDF to read through.  Each of these is specific to the adopting community and the type of innovation proposed for scale up / spread / dissemination.
2. NICE - yes, the National Institute for Health & Clinical Excellence (NHS) has been at the forefront of providing tools that support the introduction of evidence. These are excellent spreadsheets, populated with the NHS data and ready to use.  Unfortunately, I don't hear about them being used on a regular basis - especially by commissioners.

The problem with tools and diagnsotics is no difference than the problem with any other thing we want to spread or be adopted - most people would prefer to create their own because the credibility for many members of staff lies in the excitement and status of creating their own, rather than using someone else's. If you're offered a diagnostic tool - have a good look at it - if it is specific to the innovation it may be very useful for you.

Readiness for spread, dissemination, scaling up

Spread, scaling up, dissemination, diffusion - whatever you want to calls it - does NOT happen in healthcare in the automatic "tipping point" way of Gladwell.  This is largely because in healthcare, the NHS being one great example, the desire to spread is a top-down prescriptive one - which is most companies would be dealt with a a large scale implementation project.  Similarly, just focusing on how to describe and communicate  the innovation is not enough. (I've written about this in previous posts.)

Whatever you call it and whatever methods you use, there is evidence that there are some key factors which need to be in place before you set off on a large scale "thingy".  These are not clever, and, in fact, are annoyingly obvious. Obvious does not mean simple.  You already know about the list below and one major step forward in your large scale work is to examine why you're not working on these "readiness" factors.

1. Strategic focus: if the imitative is not named and talked about in the organisation (and team) level as a strategic piece of work to do, then it's probably not a large scale change or one which will be given priority
2. Executive sponsor: who in the organisation is responsible and accountable for the implementation (not the planning) of the change?
3. Day-to-day leadership: is the initiative being talked about?
4. Spread aim: is there a clear aim and method of measuring progress for spread / scaling up?
5. Spread / scaling up Plan: is there one? Is there one that scales down each level of implementation?
6. Costs: are the costs of the change clear? DO they include the staff time coasts? Is there an agreed ROI for the scale up?
7. How will fidelity be ensured? (Fidelity = what is scaled up / spread is the same as the initiator project)

Some references:

(There are many references available in peer-reviewed papers, however, as many of you have complained you don't have access to these, I have listed some more general and open access references. If you know of other easy access references then please comment on this blog.)

• IHI: A framework for spread
• Agency for Healthcare Research & Quality: Innovation readiness for spread
• Some of my books: Rolling out your project includes a whole section on diagnosing readiness for change. 

Three Collaborative Models for Scaling Up Evidence-Based Practices

A new paper is out is Adm Policy Mental Health (See abstract below). Two of the models are those I've presented on and published about - the rolling cohort and the cascading dissemination model. There are also subsets of these methods - see my book 101 ways to improve your collaborative. 


Three Collaborative Models for Scaling Up Evidence-Based Practices

Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM.

Source

Abstract

The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed.