Use a Scale-Up Grid to Plan for Implementation

Play Strategy
What is a Play? Box

Moving from a pilot to full-scale implementation of an enhanced care program can be challenging. Some complex care programs have used scale-up grids to help them identify steps to take in each area of the implementation as they move from working with a small number of patients to a large number.

The goal of this play is to help you implement your enhanced care program.

Play: scale-up grid
How to run the Play
  1. Determine the number of people who will benefit from your program when you reach full-scale implementation, based on your enrollment criteria. Track your progress by calculating the percentage of the population you’re reaching at each phase of the scale-up.
  2. Identify the change areas that the project involves. For example, the Better Care Playbook has identified the following areas: choosing the population, engaging patients and families, developing and costing the care model, developing partnerships, and implementing, iterating, sustaining, and learning.
  3. With your team, use the example scale-up grid below to identify what you’ll need to do in each of the change areas as your program moves from pilot to full-scale implementation.
  4. Pay particular attention to the structural issues you may face as you scale up. How will you collect data on outcomes and cost and learn from what you find? How will you finance the program as it reaches full scale for the long term? Who will provide oversight of the program?
Tips and tricks
  • You should feel more confident in the effectiveness of the intervention as you test it with five and then 25 people. If doubts about its effectiveness arise, try iterating on the care model before increasing the number of people you’re serving.
  • Think about which aspects of the care model work well with five patients but might not with more. Consider whether you’ll need additional human resources, physical resources, financing, or information technology to make the intervention work at scale.
  • Consider what stakeholders you will need to engage as you move from pilot to full-scale implementation, and make sure outreach to them is part of your scale-up plan.


For More Information

This play was developed by the Institute for Healthcare Improvement (IHI) based on their work in the Better Health and Lower Costs for People with Complex Needs collaborative, which ran from 2014-2017.