Abstract
Over recent years, our multidisciplinary team has built a portfolio aimed at making scaling more structured, responsible, and equitable. Grounded in evidence from empirical studies and reviews, this portfolio has led to the development of tools, the scaling of innovations, training activities, and knowledge mobilization initiatives. Together, these contributions seek to strengthen system capacity for rigorous scaling.
Team Overview
Based in Québec, the francophone province of Canada, our team brings together members from the Chair in Shared Decision Making (Link), VITAM – Centre for Sustainable Health Research (Link), and the Québec Health and Social Services Support Unit (SPOR–CIHR) (Link). Team members come from multiple continents and a wide range of disciplinary backgrounds.
Lessons Learned
In summary, our work suggests that successful scaling depends on a solid evidence base, deliberate planning, and early integration of equity and economic dimensions. Combined with public engagement and continuous adaptation to context, these conditions are essential to support rigorous scaling.
Our empirical studies and evidence syntheses form the scientific foundation of our work and connect research to practice (Link).
Cross‑sectional and Exploratory Studies
Our early work, particularly in primary care, documented key components of effective scaling strategies and identified methodological gaps (1, 2, 3), guiding subsequent research and tool development focused on scalability assessment, documentation, economic evaluation, and patient and public engagement.
Targeted Reviews
- Systematic Review of Scalability Assessment Tools (Link). This review identified the core components required to assess the scalability of health innovations.
- Umbrella Review (Link). As one of the first syntheses of its kind, this review identified and mapped major domains of scaling knowledge and consolidated our research prioritization.
- REPOS – Scoping Review on Patient and Public Engagement in Scaling (Link). This first‑of‑its‑kind scoping review identified 23 engagement strategies structured according to the Montréal Model (care, organizational, educational, research, and policy levels), which are currently being refined through a consensus process to identify the most relevant strategies.
- EcoScaling – Systematic Review of Economic Evaluation in Scaling (Link). This review examined approaches used to evaluate the economic dimensions of scaling strategies, including the identification of direct and indirect costs associated with deployment.
- Review of reviews of Knowledge Product Implementation Strategies (Link). This review showed that the implementation of knowledge products—essential to scaling—relies primarily on mixed implementation strategies (83%), dominated by educational approaches, reminders, and feedback, with adoption being the most frequently reported outcome (89%).
- SUCCEED – Systematic Review of Reporting Guidelines for Scaling (Link). This review identified 750 items, grouped into seven sections, to support standardized and reproducible documentation of scaling initiatives, currently being refined through a consensus process.
Thematic Studies
- Pitfalls of Scaling Health and Social Innovation (Link). This study identified six major pitfalls to consider during scaling, related to cost‑effectiveness, health inequities, amplification of negative effects, ethical issues, top‑down approaches, and contextual factors.
- Spontaneous Scaling in Real‑World Primary Care Settings (Link). This ongoing study analyzes spontaneous scaling processes to document how an innovation diffuses in primary care settings in Québec.
Tools
- ISSaQ 4.0 – Scalability Assessment Tool (Link_tool, Link_study). Co‑developed with patients and the public based on evidence synthesis and an eDelphi consensus, ISSaQ 4.0 includes 37 items across 12 domains, explicitly integrating equity considerations.
- EcoScaling – Economic considerations for scaling (Link). A glossary and methodological guide addressing economic considerations in scaling health and social service innovations.
- eLARGIE – Online Open Access Training on Scalability (Link). This open‑access asynchronous training, co‑developed with citizens, equips teams to use ISSaQ 4.0 for scalability assessment.
- LENGAGE – Online Open Access Citizen Engagement Training (Link). This open‑access asynchronous training, co‑developed with citizens, supports public engagement in scaling initiatives.
Other Scientific Contributions
- Analysis of Scaling Theoretical Frameworks (Link)
- Integrating Equity into Scalability Assessment (Link)
Digital Health Innovation for Diabetes (Link). A multimethod evaluation of MyDiabetesPlan, a digital shared decision‑making tool for diabetes care, demonstrated high potential for sustainability and scaling.
Scaling Citizen Workshops in Public Libraries (Link). This study scaled workshops across 25 public libraries in Québec, reaching 362 participants, with documented knowledge gains, high satisfaction (9/10), 92% coverage, and implementation costs of CAD 6,051.84 (development) and CAD 22,935.41 (scaling).
Cluster Randomized Trial of a Shared Decision‑Making Intervention (Link). A shared decision‑making intervention—including interprofessional training, an online tutorial, workshops, and a decision aid—increased active participation in decisions among older adults (+3.3%) and caregivers (+6.1%), while reducing decisional conflict (–7.5%).
MOBILISER – Knowledge Mobilization for Scaling (Link). An innovation aimed at improving clinical results communication demonstrated local success. Structured support, including scalability assessment using ISSaQ 0, enabled adoption in a new site and identified conditions for coherent deployment.
The following activities contributed to strengthening collective capacity and promoting scaling practices in national and international contexts.
Workshop – Montreal School of Higher Commercial Studies, La mise à l’échelle des innovations en santé et services sociaux : Comment la réaliser ? (How to Scale Health and Social Innovations) (Link). Co‑designed with a citizen partner on scaling foundations and scalability assessment (ISSaQ 0).
Workshop – North American Primary Care Research Group (NAPCRG) 2024, Scaling up innovations in health and social services: how to make it happen? (Link). Practical workshop on scaling types, stages, and levers, including ISSaQ 0.
Webinar – McGill RISE³, Updating the Scaling Knowledge Base (Link). Overview of recent concepts, methods, and tools.
Expert Brief – University Institute on First-Line Health and Social Services, Scaling in Primary Care (Link). Situation analysis and key levers for rigorous and equitable scaling in Québec.
Webinar – Quebec Ministry of Health and Social Services Community of Practice in Knowledge Implementation and Transfer Sciences, Évaluation de la capacité de mise à l’échelle, une étape à ne pas sous-estimer ! (Scalability Assessment as a Critical Step) (Link). Co‑designed with a citizen partner focusing on ISSaQ 0.
SOLIDE – Vertical Scaling of Shared Decision-Making in Québec. Analysis of the role of public policy actors in vertically scaling shared decision-making innovations.
E‑SUNIMET2 – Strengthening International Scaling Standards. Analysis of barriers and facilitators to adopting the SUCCEED reporting guideline.
GUIDE REPOS – Patient and Public Engagement in Scaling. A practical guide based on the REPOS scoping review and a Delphi consensus process to integrate engagement across all stages of scaling.
