127 The spread and scale academy. Preparing teams to spread and scale solutions across their system and wider
Huw Griffiths, Ruth Jordan · 2025
Introduction Global health is in crisis. Life expectancy has dropped, health inequalities are growing wider, and climate change poses a severe threat to the lives of thousands. No single organisation is prepared or equipped to tackle this alone, meaning leaders are often facing these unprecedented, global challenges in an isolated way. Historically, we have not listened to, learned from, and shared with each other; we are lacking the space, skills or intention to do so.The three day Spread and Sale Academy has been at the forefront of The Dragon’s Heart Institute (DHI) which was created by Cardiff and Vale University Health Board following the initial waves of the COVID-19 pandemic. We recognise that there is an inability to share evidence-based improvements leading to unwarranted variation in access to quality care across Wales and beyond. The ‘know do gap’ states that it takes on average 17 years to get evidence incorporated into practice (Morris et al, 2011) and we haven’t got that time.Methods We have delivered 14 academies to over 700 learners. 74% of learners at the latest academy strongly agreed that they felt more confident in enacting large-scale change with 100% of learners stating they would recommend to a colleague.We have utilised a learning system to support the delivery and continuous development of the Academies. This has consisted of gathering feedback, engaging with delegates post event, wash ups and sense making sessions. We have drawn themes around barriers and enablers to spread and scale and utilised our extensive networks to disseminate our learning, through teams including Academi Wales and Welsh Governments National Climate Emergency team and Future Generations team.The tools and techniques taught on the 3 days both cover the ‘inner work’ of leading on large scale change and the practical tools such as completing a 90-day plan. The academy enables learners to shift from asking ‘how can get all these people to do what I want them to do’ to ‘how can I help all of these people do what they want to do’.Our impact is embedded in the success of our leaners with 343 have attending our community of practice and growing the network of leaders trained in spread and scale and large-scale change. Each project brining its own challenges in measurement and we have collected information in several formats including process, value add and impact measures. We also have a several case studies, interviews and videos highlighting success.Results Learners have reported an estimated total cost saving of £6,538,620. This includes;1.1 million saved in avoiding adverse tracheostomy incidents across Waels per year£13,000 saved in rationalising the use of IV Paracemtol on inpatient wards£2.4 million saved in avoided bed days from supportive palliative care over five yearsDuring the 3-day academy leaners are pushed to ensure that their aim statement is compelling, and solutions solve the problem for those who are most affected. We ensure that the main outcome measure reflects this and is something the learners truly care about.Spread and scale is not the same as quality improvement. While there is some overlap, spread and scale is a discipline with different sets of skills required. We are at the cutting edge of this emerging field and believe we have an obligation to spread the approach to as many people as possible who can benefit from it. Our aim is that by July 2030, 10,000 leaders will be prepared and equipped to listen, learn and share with each other across organisational, national and international boundaries to solve global health challengesReference Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–520.