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What does it mean to "scale-up" an innovation? Researchers use the term differently. Some apply the term to mean moving from a small effort to a larger effort, such as transitioning from a pilot version of a nurse navigator intervention in which 30 breast cancer survivors are proactively helped by a nurse, to full-scale intervention in which all of the same clinic's 300 breast cancer patients are now offered proactive nurse guidance. That's frequently called "going to scale". Other researchers use the same term when they describe a process of spread or diffusion, as in one clinic's nurse navigator intervention being communicated to (disseminated to) other clinics which then adopt the intervention. Is that process of replication (even with adaptations along the way) also one of scaling? Many times, "scaling-up" is used to mean a marshalling of resources (i.e., "ramping up") in anticipation of deployment and demand, as a corporation does in working its distribution chain for a new product launch. The question is complicated by the issue of generalizability. If we scale a pilot to a full intervention in one clinic, we almost certainly increase the variability of the people who experience the program. They may all still be cancer patients, but now we have older patients, younger patients, sicker patients, the newly diagnosed, Hispanics and Asians, a broader representation of people now interacting with the intervention. Some economists reserve the term "scale-up" to only mean extension of an intervention to greater numbers of similar people. In this way, variability does not increase (theoretically, to the economic mind) and the only variable at work is scale. That perspective is, in many cases, a good description of the diffusion of innovations, though in practice innovations very often spread to people & places where they were never purposively intended to go.

Jim Dearing
Director/PI, CCRC
KPCO

Written by CCRC at 13:15

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