The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review

Abstract

Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.

A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework

“…There exists a gap in the literature between the postulated benefits of health innovations, and the actual outcomes of these innovations when deployed in practice, which often fall short of their predicted benefits [ 24 ]. In particular, health system transformation via virtual care technology innovations, which is the focus of the DigiComp Kids project, is often undertaken by research teams without adequate attention paid to involvement of end-users in the design of innovations, resulting in a lack of adoption, scale, and spread [ 24 , 25 ]. The complexity of both the health innovations themselves, as well as the environmental context in which they are implemented, results in interdependent human, socioeconomic, cultural, and technological factors that influence the outcomes of health innovation implementation [ 24 ].…”

Are health systems redesigning how health care is delivered?

“…Studies have noted both the lack of an evidence base for transformation in health care 34,44 and the importance of regional and organizational context in effectively implementing innovation. 44,45 The tension between the need for models and the strategic selection and adaptation of models to fit local needs points to the importance of informed and skilled health system leaders.…”

“…Since innovation in any organization can range from a novel approach to the application of commonly used changes that are new to that particular organization, 34 we adopt Bhattacharyya et al’s three conceptualized levels of innovation to guide our exploratory analysis: improving standardization and efficiency of an existing process, innovating within an established delivery model to provide care that is not currently deployed, and disrupting the current care paradigm by employing novel approaches to address situations where customers (patients) have unmet needs 18 …”

Scale-up and sustainability of a personalized end-of-life care intervention: a longitudinal mixed-methods study

“…Whether healthcare interventions are introduced through research or quality improvement initiatives, scaling up and sustaining them is challenging, even when worthwhile to patients, practitioners, or the public [ 5 ]. Program scale-up and sustainability are common terms in implementation science, with variable definitions [ 6 , 7 ]. Aligned with the World Health Organization, our definition of scaling up is deliberate efforts to increase the local impact of a successfully developed intervention to benefit more individuals and foster program growth [ 8 ].…”