Extending improvements to whole systems, even entire countries, is challenging but not impossible. IHI Senior Vice President Pierre Barker, MD, provides an overview of a new article that explains the evolution of IHI's thinking about how best to scale up improvements. Dr. Barker is faculty for IHI’s Getting Results at Scale seminar.
When I used the phrase “dead pilots” in a recent meeting, it resonated with many in the room. We had all had the experience of enthusiastically designing small improvement projects (pilots) that got great results, but then eventually stalled or failed completely because we couldn’t bring them to full scale. This is typically because the pilot was never designed with scale-up in mind. Often, this is because we can’t bring to full scale some of the key design elements (e.g., resourcing).
Recently, IHI Director Marie Schall, IHI Senior Research Associate Amy Reid, and I reflected on the scale-up frameworks in the literature, the many years of lessons from IHI and Associates in Process Improvement (API), and our recent experience with national programs in Ghana and South Africa. The result is a new IHI Framework for Going to Full Scale published in the open access journal Implementation Science. The framework is organized into two broad parts:
A sequence of activities required to take an idea from concept, through early testing, to broader testing, and finally rapid scale-up; and
The properties that facilitate adoption of new ideas and the infrastructure required to support the scale-up.
IHI Framework for Going to Full Scale
The article advances the notion of the “scalable unit” – a small representation of the system that allows you to test the change ideas you want to scale up, the supports in the environment (e.g., data systems, personnel), and the will that needs to be built for broader adoption of the improvements.
In addition, the article presents case studies of national-scale initiatives in Ghana and South Africa. Teams from both countries used early iterations of this framework to scale up evidence-based interventions to improve maternal and child health. Organizations from around the world can apply the lessons learned from these efforts in Africa.
IHI hopes more organizations from a variety of settings will further test the Framework for Going to Full Scale with a range of different interventions.
You may also be interested in:
IHI White Paper - Planning for Scale: A Guide for Designing Large-Scale Improvement Initiatives
Lessons Learned from Ghana's Project Fives Alive! A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives
