Spreading and scaling up innovation and improvement

Greenhalgh, Trisha; Papoutsi, Chrysanthi

doi:10.1136/bmj.l2068

Cited by 228 publications

(276 citation statements)

References 24 publications

Supporting

Mentioning

269

Contrasting

Unclassified

Order By: Relevance

“…The alert was switched from silent to live as recommended by improvement approaches for scale and spread. [25] Initially in the acute medical unit at one site, expanding out to both Emergency Departments and haematology wards and then Trust-wide. Initial areas were selected based on their interest in assistance in identifying patients with suspicion of sepsis.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

Honeyford¹,

Cooke

Kinderlerer

et al. 2019

Preprint

View full text Add to dashboard Cite

ObjectiveTo determine the impact of a digital sepsis alert on patient outcomes in a UK multi-site hospital network.MethodsA natural experiment utlising the phased introduction of a digital sepsis alert into a multi-site hospital network. Sepsis alerts were either visible to clinicans (the ‘intervention’ group) or running silently and not visible (the control group). Inverse probability of treatment weighted multivariable logistic regression was used to estimate the effect of the intervention on patient outcomes.Outcomes: In-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the Emergency Department.ResultsThe introduction of the alert was associated with lower odds of death (OR:0.76; 95%CI:(0.70, 0.84) n=21,183); lower odds of prolonged hospital stay ≥7 days (OR:0.93; 95%CI:(0.88, 0.99) n=9988); and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR:1.71; 95%CI:(1.57,1.87) n=4622).DiscussionCurrent evidence that digital sepsis alerts are effective is mixed. In this large UK study a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics, which may suggest a causal pathway. It is not known whether the presence of alerting is responsible for improved outcomes, or whether the alert acted as a useful driver for quality improvement initiatives.ConclusionsThese findings strongly suggest that the the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.FundingImperial NIHR Biomedical Research Centre: NIHR-BRC-P68711.

show abstract

Section: Methodsmentioning

confidence: 99%

“…The main outcome of interest was – timely antibiotics, defined a receiving antibiotic within 1 hour of the alert (as per NICE guidelines). [25]…”

Section: Methodsmentioning

confidence: 99%

Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

Honeyford¹,

Cooke

Kinderlerer

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…This study highlights the need to rethink interventions when going to scale and to highlight these in the literature for future implementation processes to learn from. Agile project management schemes (32), cost evaluations and system approaches are important tools in achieving sustainable programmes (33). We also encourage the use of the MAPS toolkit for project managers to provide them with resources to assess the maturity of their mHealth programme and stage-based strategies for scale-up (13).…”

Section: Implications For Future Digital Health Solutions At Scalementioning

confidence: 99%

The complexity of scaling up an mHealth intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

Fruchtman

Mbuyita

Mwanyika‐Sando

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.

show abstract

“…These gaps include (a) poor description of scaling strategies, (b) lack of mention of the type of scaling strategy (e.g., vertical, horizontal), (c) unclear distinction between the EBP and the strategies used to scale the EBP, and (d) inconsistent reporting (e.g., no information on assessing the scalability of the EBPs, lack of a clear measure of the scaling outcome). Our goal for proposing the new reporting guideline is to help address these gaps in reporting and knowledge translation related to the scaling of EBPs, including lack of assessment of potential harms, little information on sex and gender issues, and absence of patients and public engagement in designing the scaling strategies [3,20]. Figure 1 depicts the place of scaling in the context of knowledge translation and the incremental contribution of SUCCEED reporting guideline.…”

Section: Introductionmentioning

confidence: 99%

Essential items for reporting of scaling studies of health interventions (SUCCEED): protocol for a systematic review and Delphi process

Gogovor¹,

Zomahoun

Charif³

et al. 2020

Syst Rev

View full text Add to dashboard Cite

Background: The lack of a reporting guideline for scaling of evidence-based practices (EBPs) studies has prompted the registration of the Standards for reporting studies assessing the impact of scaling strategies of EBPs (SUCCEED) with EQUATOR Network. The development of SUCCEED will be guided by the following main steps recommended for developing health research reporting guidelines. Methods: Executive Committee. We established a committee composed of members of the core research team and of an advisory group. Systematic review. guidelines will also be contacted. Study selection and data extraction will be conducted independently by two reviewers. A narrative analysis will be conducted to compile a list of items for the Delphi exercise. Consensus process. We will invite panelists with expertise in: development of relevant reporting guidelines, methodologists, content experts, patient/member of the public, implementers, journal editors, and funders. We anticipated that three rounds of web-based Delphi consensus will be needed for an acceptable degree of agreement. We will use a 9-point scale (1 = extremely irrelevant to 9 = extremely relevant). Participants' response will be categorized as irrelevant (1-3), equivocal (4-6) and relevant (7-9). For each item, the consensus is reached if at least 80% of the participants' votes fall within the same category. The list of items from the final round will be discussed at face-to-face consensus meeting. Guideline validation. Participants will be authors of scaling studies. We will collect quantitative (questionnaire) and qualitative (semi-structured interview) data. Descriptive analyses will be conducted on quantitative data and constant comparative techniques on qualitative data. Discussion: Essential items for reporting scaling studies will contribute to better reporting of scaling studies and facilitate the transparency and scaling of evidence-based health interventions.

show abstract

Spreading and scaling up innovation and improvement

Abstract: Disseminating innovation across the healthcare system is challenging but potentially achievable through different logics: mechanistic, ecological, and social, say Trisha Greenhalgh and Chrysanthi Papoutsi

Cited by 228 publications

References 24 publications

Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

The complexity of scaling up an mHealth intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

Essential items for reporting of scaling studies of health interventions (SUCCEED): protocol for a systematic review and Delphi process

Contact Info

Product

Resources

About