Beyond Pilots: Scaling and Spreading Innovation in Healthcare

Long after Monique Bégin first remarked that Canada is a country of pilot projects (Bégin et al. 2009), health leaders continue to debate how best to scale, spread and sustain innovations that deliver value. This test has proven to be one of the core challenges – and opportunities – of modern health systems. Great ideas don't always make it beyond local pilots and can fizzle over time as champions move on. In fact, the idea for this editorial came from a meeting where several leaders argued that innovations never spread – that the health system was, in fact, incapable of achieving change at scale.

There are definitely times when change in the health sector is frustratingly slow, with promising innovations getting mired in a variety of roadblocks or stuck as local gems that fail to benefit those in other services or regions. It is clearly important to study and learn why this happens. Healthcare Policy/Politiques de santé has published research and commentaries with many examples of this phenomenon over the years and will continue to do so. In fact, you will find several related articles in this issue of the journal alone.

But it is not true that all innovations fail to grow and deliver value beyond the context in which they were first introduced. Studying these successful experiences can be at least as instructive as learning from the failures, just as it is important to understand why not all individuals with what appear to be similar risk factors develop health problems. In fact, this resilience may provide important clues about how to improve health more broadly.

With this in mind, I started scribbling a list of innovations that had scaled and spread, from electronic medical records (EMRs) in primary care to programs that are eliminating polio and other communicable diseases on a global scale. Take the former as an example – according to the National Physician Survey, 77% of primary care physicians now report using EMRs, up from 37% five years ago, and rates continue to grow, with many of today's paper practices indicating that they plan to use EMRs within the next two years (NPS 2015). In a few minutes, I had a list of innovations that had outgrown the small pad of paper provided by the hotel and at the break my table companions added many more examples to the tally.

For further inspiration, I turned to social media. Perhaps the most pervasive – and still growing and evolving – innovation of recent years, it is also a fast way to crowdsource a range of ideas and perspectives from a diverse global community. Since I am connected via LinkedIn, Twitter, and other networks to a number of people who care about improving healthcare, I posted a request to help identify successful innovations from the last 10 to 15 years, whether from nearby or far away, resource rich or resource poor settings. I asked those responding to focus on changes that represented a substantive shift in health services delivery or organization, rather than in the use of particular drugs or specific techniques.

The result was a generous outpouring of ideas, with examples from around the world, ranging from guinea worm eradication efforts and mortality-reducing transformations in maternity care in Sri Lanka to care bundles that improve surgical safety and organizations/ jurisdictions that have introduced systematic initiatives to foster change. There were both high- and low-tech innovations, ones whose primary goal was to change culture and ones focused on very specific changes in clinical practice. I am also grateful for the new contacts and resources that I learned about as part of this process.

So what did the successful innovations have in common? Most were complex interventions that reflected best practices in change management. They were about transforming cultures as much as changing technologies or techniques, about making the right thing to do the easy thing to do. Which doesn't mean that healthcare transformation is easy. The examples identified tended to reflect an understanding that for a new approach to become the accepted ‘way we do things around here' involves a collective effort with thought to governance and leadership, stakeholder engagement, communications, training and education, workflow analysis and integration, and monitoring and evaluation.

Want to join the discussion? I invite you to do so via social media or by submitting research or evidence-informed discussion and debate articles to Healthcare Policy/Politiques de santé. In doing so, you will join a diverse community of authors writing about a wide range of health policy questions. For instance, this issue of the journal addresses enablers and barriers to the reform of primary care, regulation of health professions, advancing care for individuals with cancer, substance use challenges, and much more. I hope that these articles will stimulate your thinking about healthcare transformation, whether at a local or global level.