The unpredictable journeys of spreading, sustaining and scaling healthcare innovations: a scoping review
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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.
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Our experiences collaborating with rural primary healthcare teams to develop and implement the memory clinics highlighted the complex nature of the rural healthcare context and are consistent with the view of innovation as an unpredictable journey and a process of managing and supporting continuous improvement and adaptation.
“Our experiences in collaborating with rural PHC teams to develop and implement the memory clinics have highlighted the complex nature of the rural healthcare context [51] and are consistent with the view of innovation as an unpredictable journey, and a process of managing and supporting continuous improvement and adaptation [40].”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [40]
It is crucial that those involved believe the innovation improves the quality of care, because their efforts to support the innovation are motivated by the added value they want to achieve.
“A review of sustaining and scaling healthcare innovations [40] noted that it is crucial that those involved believe that the innovation improves the quality of care, as their efforts to support the innovation are motivated by the added value they want to achieve.”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [40]
Participants' belief that they are equipped and able to contribute to the program is key to maintaining motivation.
“The importance of capacity-building is reinforced by Coté-Boileau et al. [40] who found that participants’ belief that they are equipped and able to contribute to the program is key to maintaining motivation.”
From Factors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members (2022) · cites this paper as [40]
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Self-citationMaking Digital Health “Solutions” Sustainable in Healthcare Systems: A Practitioner Perspective
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Open innovation’s effects on Indonesia’s digital health market and related societal issues
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Caring for innovation: practices of compassion in health and social care
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Implementing a mental health app library in primary care: A feasibility study
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Controversies in employee-driven innovation: Exploring the Danish public healthcare
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What Matters Most: an Age-Friendly approach to pathology and laboratory medicine
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Guía para adaptar y aplicar directrices informadas por la evidencia. Segunda edición
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Scaling Up Departmental Health Insurance Units in Senegal: A Mixed-Method Study
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From perpetual pilots to sustainable transformation: Scaling up geriatric care
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Key elements involved in scaling-up inclusive healthcare - A Scoping Review
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Dietistens arbete inom palliativ vård i Sverige
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- Authors
- Côté-Boileau, É., Denis, J.-L., Callery, B., & Sabean, M.
- Affiliations
- Université de Sherbrooke (CA)
- Université de Montréal (CA)
- Canadian Foundation for Healthcare Improvement (CA)
- Corresponding author
- Côté-Boileau, Élizabeth
- Venue
- Health Research Policy and Systems
- Published
- 2019-09-13
- Volume
- 17
- Issue
- 1
- Pages
- 84-84
- ISSN
- 1478-4505 (ISSN-L)
- PMC
- PMC6744644
- OpenAlex
- W2972745945
- Cited by
- 133
- References
- 118
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 34 · 2023: 23 · 2022: 19 · 2021: 24 · 2020: 6 · 2019: 1
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Health Research Policy and Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Canadian Foundation for Healthcare Improvement
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Keywords
- healthcare innovation, diffusion of innovations, innovation sustainability, health system transformation, innovation framework, perceived value, feasibility, inclusivity, capacity building, health system actors
- MeSH terms
- Delivery of Health Care, Diffusion of Innovation, Quality Improvement
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