Summary and Conclusions

“We want … to deputize you, and I hope that you have been inoculated with the Million Hearts™ virus and will take that forward.” 
Janet Wright, Million Hearts™ Executive Director

The Million Hearts™ Scaling and Spreading Innovation: Strategies to Improve Cardiovascular Health event was a 1-day invitational event at which experts, stakeholders, and health care systems explored issues related to spreading innovations that could contribute greatly to the Million Hearts™ goal of preventing a million heart attacks and strokes. The participants were selected to represent the variety of perspectives that would need to be considered in order to assure the success of potential large-scale initiatives to scale up and spread these and other innovations aimed at achieving the goals of the Million Hearts™ initiative. The day-long dialogue, facilitated by a creative meeting format, encouraged the open discussion of the many challenges that would have to be addressed for successful spread of novel and effective health care practices.

Four innovations from the AHRQ Health Care Innovations Exchange served to anchor the thinking for the day. The variety embodied in these innovations—in methodology, setting, staffing, and sponsorship—combined with the varied participant perspectives to uncover many important issues. To summarize:

  • For an innovation to spread, it is critical to define its core elements, which have to be preserved in all efforts to implement the innovation in other settings, while recognizing the importance of adapting and tailoring other elements to the requirements of each implementation setting. Distinguishing between core and adaptable elements is not a simple task.
  • Innovations need to be “packaged” for spread. Their benefits must be clearly and strongly stated, in terms that are relevant to each stakeholder audience. Because innovations are often complex, packaging must include an array of implementation aids: training, operational manuals, organization charts, process flows, and the like. Few innovations have the necessary implementation packages.
  • In many cases, innovators have no interest, or skill, in spreading their innovations. Thus, for spread to occur, innovators must be connected with spread agents, which can take a variety of forms.
  • Many stakeholders have to be activated and aligned in order for innovations to spread effectively. A robust multistakeholder infrastructure will be needed to speed up the spread of cardiovascular and other innovations throughout the health care sector. For spread efforts to succeed, innovators must engage multiple stakeholders, including hospital/health system leadership, providers, patients and families, communities, employers, public entities, private funders, connectors, adopter organizations, and spread organizations. The benefits to these stakeholders need to be articulated in a compelling and targeted way.
  • Potential adopter organizations must provide fertile ground for the innovation. A culture that is generally open to change is critical, but any specific change must align with the organization’s current priorities. Organizational change champions are critical to overcome the inevitable barriers that face any effort to do things in a different way.
  • Many implementation tactics, at macro and micro levels of organization, must be explored. Some of these tactics have a broad focus, such as organizational partnerships and collaboration by entities that have not traditionally worked together, and the use of media to create awareness and demand for innovative approaches to care delivery. Other tactical considerations are more targeted to individual adopter organizations; these include approaching innovation efforts incrementally versus aiming for more comprehensive programs at the outset, adopting a narrower stand-alone program, and exploring integrated solutions.
  • Efforts to spread improvements in cardiovascular health and other innovations may be assisted by transformations that are underway in the health care environment. These include payment systems that are moving from volume-based schemas to ones that emphasize value and outcomes, changing roles and scope of the health care workforce, and development of new provider and delivery systems. The potential for an important role of traditional and new media in promoting the spread of these innovations has yet to be exploited. Scaling and spreading innovations will be facilitated by exploring their possible integration into larger experimental models (e.g., Patient-Centered Medical Homes and ACOs), which will likely become part of the health care landscape in the near future.

These lessons elicited from the Million Hearts™ event suggest elements of a roadmap for building the infrastructure needed for large-scale spread of cardiovascular innovations in order to achieve the ambitious goals of the Million Hearts™ initiative. To prevent a million heart attacks and strokes within 5 years, urgent efforts are needed at all levels of the health care system. The thought leaders participating in this event identified key activities needed to extend the work of the innovation developers to a critical mass of other health care organizations. They noted that these activities are challenging, and they require new partnerships and new ways of working at many levels in the many different organizations that make up the nation’s health care system. Can these thoughts move from the idea stage to urgent action?

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