I can't believe it's not better

Nick Bland, Co-Director at What Works Scotland, shares reflections on an evidence review, ‘Scaling-Up Innovation’, published today as part of What Works Scotland’s workstream on Spread and Sustainability.

It’s a truism to say that transforming public services to deliver better services is complex and difficult - but no less true for that. And for public services to work increasingly in partnership, with communities, to deliver shared outcomes, it’s even more so. 

One aspect of that aspiration for transformation in Scotland is an increasing focus by public bodies on the ‘spreading’ or ‘scaling-up’ of initiatives or interventions identified as effective. There may be a risk that some of this focus stems from an assumption that spread or scale-up offers a slightly easier way of meeting this challenge, or perhaps is a means with more chance of success. It’s certainly not the only approach to transformational change: the creation of a single police and a single fire & rescue service are recent examples of large-scale organisational transformation.

Today we publish a review of evidence on scaling up innovation that identifies more specifically why it is difficult, and the crucial elements that need to be attended to for any chance of success. The review meets a specific commission from Scottish Government and is the first output under our Spread and Sustainability workstream.

The evidence review was produced by What Works Scotland’s Evidence Bank, which provides appraised, accessible and action-oriented reviews of existing evidence. A structured approach was applied to identifying appropriate evidence to consider work covering interventions and initiatives across education, health, social care, justice and others. The review draws out from this diverse range of evidence the issues that were most common and could be applied to public services.

As the workstream lead, some of the things that stand out for me from the review are:

• The need for any initiative or intervention to be clearly understood in terms of: what outcomes it delivers, for who, and how, and in what context. There’s a lot of detail in each of those elements. But that clarity and depth of understanding is central to any attempt to successfully spread or scale-up.
• Many different terms are used. They are not synonyms but describe different, sometimes subtly different, processes. We need to be alive to these differences and their implications when put into practice. (I’m still looking for language that allows me to talk about it in more neutral terms.)
• There is a risk that these terms are interpreted as describing a linear process. What’s clear from the review is that any attempts at spread need careful consideration of the characteristics and dynamics of the social systems in which they take place. It’s not as simple as spreading your low fat alternative across your toast.
• One should be careful in considering the role of the actor that decides to, and is responsible for, ‘spreading’ an initiative. The areas, teams, or sites to which an intervention is spread should not be passive actors in the process. They have an active role to play in the implementation of the intervention in that new context; how to adopt the ‘key’ elements of an intervention, yet adapt it to suit local circumstances is a central challenge. There needs to be the capacity and capability to do this.
• And it raises other questions: How does this approach to change relate to others- such as large-scale transformation, or a whole system approach? What are the circumstances in which spreading is the best, and the most appropriate, approach to transformational change? Do we also need to consider how to ‘scale-back’ or ‘scale-down’?

I hope, and expect, other things stand out for you. This is an important basis for debate and discussion as we take this work forward. So what are our next steps?

The review provides a useful foundation for the future work of the Spread and Sustainability workstream. We will organise a workshop in the autumn to bring together researchers working in this area and practitioners concerned with trying to do ‘spread’. This will help to develop a What Works Scotland position paper on spread and sustainability, and start to identify how we might explore the issues in the review in practice, in the context of ambitions in Scotland.

In the meantime, if you would like to start a conversation, please contact me at nick.bland@ed.ac.uk