One goal of the SUS events was to elicit recommendations on research that would advance the knowledge base on Scale Up and Spread. There was much interest in further investigation of the innovation–adoption-implementation process using a variety of methods, including case studies and surveys. The Innovations Exchange collection could serve as a database from which case studies exploring various topics could be explored. Examples of research questions on these topics include:
- What tools and processes are needed to make innovations successful?
- What incentives do innovators have to innovate, and then to spread their innovations? What are their constraints?
- What types of leadership support are essential for successful implementation of innovation? What are effective ways of obtaining leadership support?
- How can the costs of innovation be identified, across the variety of organizational units affected, and over time, as innovations mature?
- What are the unique considerations in spreading innovations to resource-constrained providers for vulnerable populations? For example, how do cultural competency issues affect scale up and spread for specific vulnerable populations?
- How can innovative cultures be stimulated in health care organizations?
- What are alternative ways of bridging the gap between innovators and adopters? How effective are peer to peer spread initiatives, e.g. learning networks?
Support for scholarly work on scale up and spread
Research on topics related to Scale Up and Spread faces challenges because of the small number of legitimate publication outlets for this work, and there is still a dearth of recognition of the value of this work within traditional medical scholarship. Discussions in the SUS events emphasized the importance of creating publications specifically aimed at this emerging body of work. Creating special issues in publications such as Health Affairs or the Journal of Quality and Safety is one approach to addressing this need. Another suggestion was to recommend special sections on health care innovations in traditional medical journals such as the New England Journal of Medicine.
Another approach to enhancing the legitimacy of this emerging field of research is to establish a National Research Center for Innovation, Scale up and Spread, which can be structured in many ways, ranging from traditional academic centers located in universities, foundation-based centers, or a multi-institutional consortium that may include different types of stakeholder organizations.