Abstract
BackgroundExpanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada.MethodsWe conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research.ResultsThis study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes.ConclusionsEfforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond.
Highlights
Expanding healthcare innovations from the local to national level is a complex pursuit, for projects pertaining to eHealth services
Analyses of unsuccessful efforts to scale-up have identified common challenges, which include underestimating the resources required for scale-up, failure to understand the importance of politics and policy in successful scale-up, not considering the conditions needed for scale-up early in the process of innovation development, and an overemphasis on either the vertical or horizontal spread of innovations as opposed to considering both [3]
Identifying population care needs and access problems Participants discussed the importance of keeping the needs of the target population central to any efforts to spread and scale-up eConsult
Summary
Expanding healthcare innovations from the local to national level is a complex pursuit, for projects pertaining to eHealth services. The authors of this study emphasised that the realities of dealing with the multiple complexities of healthcare require a contextualised and adaptive approach that can evolve with a rapidly shifting policy context or continued evolution of the technology. Such complexities are especially evident in the Canadian context. Communication between provinces is limited and there is little to no capacity for sharing or distribution of innovations These challenges have caused Canada to gain a reputation as a “land of perpetual pilot projects”, where promising solutions fail to gain traction beyond the regional level [6]. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada
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