The Scale Up and Spread events identified needs for tools, training, and other activities that are important to facilitating the spread of innovations. Many of these needs are wide ranging, and could serve as the basis for a development agenda involving different stakeholders interested in promoting the spread of innovations in health care. In addition, the SUS events also identified areas recommended for specific consideration by the Innovations Exchange. This section discusses both sets of needs.
Tools for scale up and spread
Readiness assessment tools
The need for readiness assessment tools focused on the innovation’s readiness for spread and on the adopter organization’s readiness for adopting and implementing an innovation was a persistent theme throughout the different discussions on SUS.
- Innovation readiness for spread: Section II above summarizes a variety of issues related to how the innovations should be structured to facilitate spread. Much of the discussion identified attributes of “spread ready innovations” (e.g. Is the evidence robust? Are the essential core elements of the innovation clear? Has the innovation been optimized for efficiency and cost? Can the benefits for all relevant stakeholders be stated clearly? What is its competitive advantage?), which would be incorporated into a tool that would help innovators prepare their innovations for scale up and spread. In addition, the event pointed to the importance of understanding and minimizing direct and indirect cost factors related to the innovation, and the different returns (ROI) that various stakeholders might expect from implementing the innovation. Such tools would also incorporate innovation attributes such as relative advantage and trial ability identified in prior work such as Rogers (op. cit.).
- Adopter organization readiness: The SUS events underscored the importance of getting the adopter organization ready for implementation of innovations. Tools to assess adopter readiness might be developed for use by innovators and their spread partners, or by the adopting organizations. Many of the issues that are important from the adopter organization’s vantage point are well covered, but not in tool form, by Will It Work Here? A Decisionmaker’s Guide to Adopting Innovations (http://www.innovations.ahrq.gov/guide/guideTOC.aspx). The tools would include consideration of readiness attributes that are generally important, regardless of the specific nature of the innovation (e.g., presence of a strong and skilled internal champion, the support of organizational leadership, internal organizational culture, capacity, and available resources). In addition, because there is enormous variability in what the innovations would require of adopter organizations (e.g., space, staff, technology, compatibility with organizational culture, disruptions that can be anticipated), innovation-specific readiness tools would also be helpful. An example of the latter is a readiness tool from Centering Healthcare (http://centeringhealthcare.org/pages/centering-model/site-readiness.php), which the spread organization can use to assess the potential adopters readiness to implement the innovation.
Market and environment assessment tools
Market and environment assessment tools would be useful for examining the external environment of the innovation, including the size and readiness of the “market” of potential adopters, advantages over competing innovations, the range of stakeholder interests, the regulatory context of the innovation, and potential barriers (particularly reimbursement). The intent of these tools would be to assist innovators and their spread partners with identifying the external factors that may affect the success of scale up and spread efforts, and to address these factors in their scale up plans. These tools are likely to be used by innovators and spreaders iteratively in the process of preparing the innovation for scale up initiatives. These tools may also be of use in sensitizing potential funders of demonstration projects to these factors, to aid in their decision making.
Return on investment (ROI) calculators
Return on investment tools would help innovators understand and explain the practical financial implications of implementing their innovation. This type of understanding, not typically part of the innovators’ skill repertoire, is essential to obtaining the support of institutional leadership and payers such as insurance companies. ROI tools would also provide potential adopter organizations with realistic expectations. An example of a ROI Calculator developed for Medicaid projects can be found at http://www.chcs.org/resource/the-medicaid-return-on-investment-template/. This calculator was designed to be used retrospectively to determine the ROI of quality improvement initiatives. An example of a disease-specific ROI calculator is the AHRQ Asthma ROI Calculator, which estimates the potential health care savings and productivity gains of a quality improvement program focused on asthma (http://statesnapshots.ahrq.gov/asthma/UserGuide.jsp).
Innovation Selection Tools for Potential Adopters
The Innovations Exchange includes many related innovations that use different methods to address similar issues. For example, over 35 innovations in the collection provide different solutions to the important problem of preventing hospital readmissions. Tools that offer selection criteria (e.g., simplicity, high impact, low cost) or decision trees would help potential adopter organizations sift through the many potential offerings. Such selection tools would supplement the AHRQ resource Will It Work Here? A Decisionmaker’s Guide to Adopting Innovations (http://www.innovations.ahrq.gov/guide/guideTOC.aspx).
Tools to assess implementation success
Some innovators interested or engaged in spread efforts lack the training and tools to assess the success of their spread efforts. This is particularly the case for innovators who are not connected to university or research settings. For these innovators, providing tools to help them evaluate the adoption and implementation of their innovations would be useful. Such tools might include evaluation guides such as those located athttp://www.innonet.org/client_docs/File/evaluation_plan_workbook.pdf (Adobe Reader is required to view or print the PDF. Download a free copy here.). Standard measures to assess the nature and extent of adoption and implementation within organizations would also be helpful for innovators and their spread partners.