Sustainability, Spread and Scale Up

of Improvement
Module Objectives

 Sustain improvement
results, spread and scale
up successful changes
 Describe key practices
needed to sustain
improvement
 Effectively plan and
manage diffusion of
innovation through
spread and scale up
 Large Group Discussion

 What is….?

 Sustainability

 Spread

 Scale up
“Is not a project with an end-point. It is rather a constant
effort to embed a change into the fabric of daily work”

SUSTAINING IMPROVEMENT
The Aurum Institute: How to sustain and spread
improvement
IMPROVED RESULTS…
WHAT NEXT?
Sustaining Improvement

1. Standardize:
Establish or update
specific policies,
procedures, treatment
standards, guideline etc.

Make it hard not to

follow the new process!
The Improvement Guide p195-216
 Sustaining Improvement

2. Remove the old system

Case: New registers have been introduced to capture TB
patients and their treatment. Everybody is supportive of
the new system. When the new register gets full after a
month, someone replaces it with an old register that was
still available. Without noticing, staff continuous its
documentation in the old register. When the in-charge
notices, the staff is resistant to now use the new register.
The Aurum Institute How to sustain and spread improvement (2014); 5 Million Lives
Campaign (2008)
 Sustaining Improvement

3. Document
Documentation
means more work;
unfortunately,
changes are only as
good as their
documentation.

The Improvement Guide

p195-216
 Sustaining Improvement

4. Measure
Measurement is a
source of learning
during implementation
and a method of
tracking whether
improvement is
sustained. Make use
of a ‘dashboard’
The Improvement Guide p195-216; The Aurum Institute How to
Guide (2014)
 Sustaining Improvement

5. Train
The type of change
that is being proposed,
who will be asked to
implement the change,
and the skill level and
work experience of the
target group are all
considerations in how
much training is done The Improvement Guide p195-216
Sustaining Improvement

6. Supportive
Management Structure
Quality of care is a high
priority, accountability
systems are created,
resources made available
and successes recognized
The Improvement Guide p195-216; 5 Million Lives
Campaign
 Sustaining Improvement

7. The Social Aspects

Connect with hearts as
well as minds, engage
with individuals’ values
and beliefs

The Improvement Guide p195-216; The Aurum

Institute (2014)
DIFFUSION OF INNOVATION
 Large Group Exercise – Role Play

 20 Volunteers
 Be creative and have courage
 Courage “of the heart” – personal presence,
authenticity and involvement
 Creativity “to make” – making a difference of any
kind is a creative act
 Identified Game Area (e.g. 10 by 10 meter)
 Time: 35 minutes
The Context Institute (1996) The Innovation
Diffusion Game
 Role Play Instructions

 Context: Drinking coffee is suspected to be the

cause of a recent outbreak of an unknown
disease; in the past week 121 lives were taken

We are trying to introduce a change that will

stop the population from drinking coffee,
let’s see whether the innovation will spread

The Context Institute (1996) The Innovation

Diffusion Game
 Debrief Discussion – Role Play

 What worked well?

 What didn’t?
 Why?
 Who was playing what role?
 How did that feel?
 What went through your mind when playing the role?
 Was the change/innovation good?

The Context Institute (1996) The Innovation

Diffusion Game
 “Never doubt that a small group of thoughtful,
committed citizens can change the world. Indeed,
it’s the only thing that ever has.”
-Margaret Mead
Successful Innovations

 Relative Advantage
 Compatibility
 Complexity
 Trialability
 Observability
 Framework for Spread and Scale Up
Leadership
-Topic is a key strategic initiative
-Goals and incentives aligned
-Executive sponsor assigned
-Day-to-day managers identified

Measurement and Feedback

Set-up Social
-Target population System
Better -Adopter -Key messengers
Ideas audiences -Communities
-Successful sites -Technical support
-Develop the case -Key partners -Transition issues
-Describe the ideas Co
m
-Initial spread strategy
t ec m u n
hn i ic
c a l a t io n
) Str
Knowledge Management a te g
ies
(aw
a re
ne s
s&
Nolan et al., Using a framework for spread (2005); The Improvement Guide
 Strategies for Spread and Scale Up

 Natural Diffusion
 Executive Mandate
 Extension agents (field consultants)
 Emergency Mobilization

 Learning Networks
 Quality Initiatives

 Hybrid Models
Framework for Scale Up
 Module Summary

 Work in pairs, share your experience with

respect to diffusion of innovations
 Was the type of diffusion spread or scale up?
 Did the innovation meet all 5 key characteristics for
successful change?
 Was the diffusion successful; what went well, what
did not?
 Who was the innovator, the early adopter and who
were the laggards in adopting the change?