Few interventions that succeed in improving healthcare locally end up becoming spread and sustained more widely. This indicates that we need to think differently about spreading improvements in practice. Drawing on a focused review of academic and grey literature, the authors outline how spread, scale-up, and sustainability have been defined and operationalised, highlighting areas of ambiguity and contention. Following an overview of relevant frameworks and models, they focus on three specific approaches and unpack their theoretical assumptions and practical implications: the Dynamic Sustainability Framework, the 3S (structure, strategy, supports) infrastructure approach for scale-up, and the NASSS (non-adoption, abandonment, and challenges to scale-up, spread, and sustainability) framework. Key points are illustrated through empirical case narratives and the Element concludes with actionable learning for those engaged in improvement activities and for researchers. This title is also available as Open Access on Cambridge Core.
Biografie (Trisha Greenhalgh)
Trisha Greenhalgh is Professor of Primary Health Care at University College, London and a practising GP. Her main areas of interest are§- Web based teaching and learning, especially for health care professionals§- Evidence based health care and quality improvement, especially in relation to multiprofessional and interdisciplinary working§- Health service management, especially organisation, delivery and evaluation of diabetes services in primary care§- Use of personal narrative to explore the patient's perspective and illness experience, especially in relation to diabetes in minority ethnic groups
