Sustainability, scale up & spread
Sustainability, scale up and spread are important steps in the quality improvement journey. They consider the growth and longevity of a project.
Sustainability looks at whether the work can be maintained and embedded into everyday practice. Sustainability is important to quality improvement as quality improvement is not a ‘one-off’ exercise, it is work that aims to improve the ongoing processes and experiences of a system. While there may be great ideas for improvement, if they can not be implemented consistently and reliably, they will not result in improvement.
Scale up is when the improvement begins to be implemented deliberately in new ways, with new cohorts or in new places. An example may be a project that started with asthmatics attending for reviews rolling out to hypertensive patients.
Spread is typically considered when the project or work begins to be implemented across a whole system and is considered best practice. An example may be multiple practices testing and implementing care navigation.
Resources
Seven Spreadly Sins - an infographic by IHI highlighting seven of the top things to avoid when trying to spread your work.
Learn more about spread access across the NES QI Zone here.
Learn more about the Scottish Approach to Change’s information on spread here.
Read The Healthcare Improvement Studies Institute’s guide to spread, scale-up and sustainability here.
NHS England Sustainability Model - a detailed document outlining steps that can be taken to work towards sustainable quality improvement.
