Joe McCannon, IHI, Chair Brian Mittman, PhD, VA/CIPRS, Co-chair Wynne Norton, PhD, UAB, Co-chair

1. June 25, 2010 A Conference to Advance the State of the Science and Practice onScale-up and Spread of Effective Health ProgramsInformational WebEx Session Joe McCannon, IHI, Chair Brian Mittman, PhD, VA/CIPRS, Co-chair Wynne Norton, PhD, UAB, Co-chair Funding for this conference was made possible in part by grant 1R13HS019422-01 from the Agency for Healthcare Research and Quality (AHRQ).  The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. The Commonwealth Fund, The Veteran’s Health Administration, The Donaghue Foundation and The John A. Hartford Foundation also provided meeting support.

2. Meeting Supporters • The Commonwealth Fund • Agency for Health Care Research and Quality • US Department of Veterans Affairs • Donaghue Foundation • John A. Hartford Foundation

3. Planning Committee Members • David Atkins, VA • Anne-Marie Audet, Commonwealth Fund • Chris Bailey, WHO • David Chambers, NIMH • Lindsay DeGennaro, IHI • Denise Dougherty, AHRQ • Don Goldmann, IHI • Chris Gordon, NIMH • Deborah Jenkins, VA • Paul McGann (and designee), CMS • Rashad Massoud, URC • Todd Molfenter, U Wisconsin • John Ovretveit, Karolinska Institute • Marie Schall, IHI • Mary Taylor, Gates Foundation

4. Today’s Agenda • Meeting Background • Meeting Objectives • Desired Outputs • Meeting Agenda • Meeting Work Groups • Attendee Role • Non-attendee Role • Questions and Discussion

5. Background - Why Are We Here? • We possess an enormous amount of knowledge about effective practice that is not broadly applied. • We need to create a system – consisting of diverse actors - to test, prioritize and spread effective practice much more quickly and broadly. • We need to expand our thinking to include new incentives for change, new methods for spreading change, new mechanisms for measuring progress, etc.

6. Background - Why Are We Here? (cont.) • To build on the momentum of our prior meeting and a number of other recent initiatives • To respond to clear demand (urgent need, reform environment) • To sharpen a vague research and practice agenda • To create a community of peers • To develop a blueprint for action

7. Why Aren’t We Here? • To rehash what we know already • To focus exclusively on theory • To focus solely on the perspective of one stakeholder group • To study scale up without attention to present context (e.g., recent reform)

8. Conference Aims • To review existing knowledge and current practices related to the scale-up and spread of effective practice in health care and public health; • To identify key challenges and gaps in current research, policy, and practice related to scale-up and spread in health care and public health; • To develop and disseminate a detailed agenda outlining critical research, policy, and practice initiatives on these topics for the next five to seven years; and • To launch specific activities to operationalize this agenda, creating a plan of action to prioritize research, policy, and practice activity and initiating powerful demonstrations of regional, national, and international scale-up in health care and public health.

9. Proposed Deliverables • Detailed agenda for research and practice • Refined hypotheses about key factors in scale up • Refined framework for spreading better practice (and a list of common barriers) • A durable learning network (before, during and after) • A set of “performance challenges”  • Peer-reviewed publication • Conference presentations • Proceedings/report of conclusions

10. Conference Aims • To review existing knowledge and current practices related to the scale-up and spread of effective practice in health care and public health; • To identify key challenges and gaps in current research, policy, and practice related to scale-up and spread in health care and public health; • To develop and disseminate a detailed agenda outlining critical research, policy, and practice initiatives on these topics for the next five to seven years; and • To launch specific activities to operationalize this agenda, creating a plan of action to prioritize research, policy, and practice activity and initiating powerful demonstrations of regional, national, and international scale-up in health care and public health.

11. Conference Content • General meeting overview, logistics, worksheet, attendee information • Four commissioned papers (health care, public health, international, general framework) • Five background papers • Three case studies • Bibliography • Database of research and practice

12. Conference Aims • To review existing knowledge and current practices related to the scale-up and spread of effective practice in health care and public health; • To identify key challenges and gaps in current research, policy, and practice related to scale-up and spread in health care and public health; • To develop and disseminate a detailed agenda outlining critical research, policy, and practice initiatives on these topics for the next five to seven years; and • To launch specific activities to operationalize this agenda, creating a plan of action to prioritize research, policy, and practice activity and initiating powerful demonstrations of regional, national, and international scale-up in health care and public health.

13. Targeted Conference Attendees • Donors • Payers • Practitioners • Researchers • Policymakers • Media • Industry • Patients and families

14. Represented Organizations (Abbreviated) • IHI • VA • AHRQ • UAB • Commonwealth Fund • Donaghue Foundation • John A Hartford Foundation • Gates Foundation • Robert Wood Johnson Foundation • Social Impact Exchange • Kaiser Permanente • Health Partners • Iowa Health • WHO • US Dept of Education • CDC • CMS • USAID/URC • NIH • NIMH • Canadian Institutes of Health • ABIM • AHA (HRET) • Georgetown • Harvard • Yale • Johns Hopkins • Stanford • UNC • University of Texas • University of Washington • University of Wisconsin • UCSF • UCLA • Karolinska Institute • Penn State • Michigan Hospital Association (Keystone) • Blue Cross Blue Shield Association • Common Ground • Common Knowledge Associates • CFAR • Expandnet • McKinsey • Et al.

15. General Agenda • Revisit core framework (lens) • Envision the ideal system for scale-up and spread (identify new levers for change, untapped “abundance”) • Identify gaps • Make recommendations for action • Make commitments to action

16. Core Framework (Drivers of Scale-up) • The current environment for change in which scale up will occur • The foundation (or pre-history) for the work in question • The framing (especially aims) for the work in question • The nature of the intervention to be spread • The structural context into which the intervention will be spread • The method for spreading new knowledge and executing change (including the method of evaluation).

17. General Agenda • Revisit core framework (lens) • Envision the ideal system for scale-up and spread (identify new levers for change, untapped “abundance”) • Identify gaps • Make recommendations for action • Make commitments to action

18. Meeting Norms • Hands-on participation (very limited didactic sessions) • Value creativity  • Value diverse opinion and experience (welcome creative tension) • Rapid transition from recommendations to action

19. Detailed Conference Agenda Pre-Conference Activity • June 25 (11:30am eastern) – Pre-conference WebEx session (broad invitation to attendees and non-attendees, including students, patients, others) • June 28 – Launch of conference blog/web site

20. Detailed Conference Agenda Day 1: July 6th, 2010 • 6 – 8pm Reception and speakers: Panel discussion (Perspectives on Scale- up from Outside of Health Care and Public Health: Huggy Rao; Nancy Dixon; Facebook speaker TBD) Day 2: July 7th, 2010 • 8:00 – 10am Opening plenary: state-of-the-art review talks by commissioned paper writers; meeting framework and “charge” to working groups • 10 – 12:30pm Breakout period #1: Introductions; visioning exercise (each group selects 15-minute break period within this window) • 12:30 – 1:30 Lunch • 1:30 – 5:00 Breakout period #2: Gap analysis and recommendations (how will we close the gaps between the current state and the future vision) (each group selects 15-minute break period within this window) • 5:00 – 6:00 Facilitator/recorder capture notes (Break for others) • 6:00 – 7:45 Dinner/speakers: Panel discussion (Perspectives on Scale-up from Within Health Care and Public Health)

21. Detailed Conference Agenda • Day 3: July 8th, 2010 • 8:00 – 8:10am Reconvene and sharpen agenda for day • 8:10 – 9:30 Breakout groups review thinking from prior day and prepare recommendations • 9:45 – 11:00 Group report outs • 11:15 – 12:30 Open discussion and panel reactors (planning committee) • 12:30 – 1:30 Lunch and close: Report back to group on next steps • 1:30 – 3:30 Planning committee and follow-up groups meet to plan next steps

22. Detailed Conference Agenda Post-Conference Activity • July 21 (11:30am) – Post-conference WebEx session (broad invitation to attendees and non-attendees, including students, patients, others) • Ongoing blog conversation • August 30 – Draft of peer-reviewed paper(s) and draft of proceedings (issue brief)

23. Work Group Deliverables • Pre-conference: • Preparatory work sheets • Preparatory reading • At conference/post-conference: • Answers to core conference questions (recommendations) • Detailed proceedings (secretaries) • Publications (peer review, other) and other collaborations

24. Work Group Chairs • Denise Dougherty, AHRQ • Maulik Joshi, HRET/AHA • Todd Molfenter, University of Wisconsin • Marie Schall, IHI • Jurgen Unutzer, University of Washington

25. Attendee Assignment • Complete preparatory reading (Framework paper and commissioned papers, at least one case study). • Complete preparatory worksheet. • Send in your bio if you have yet to do so. • Come for the full meeting.

26. Non-attendee Role • Tune in often to the conference blog (and respond to it) • Tune into post-conference WebEx session. • Update us on your work and anything that we’re missing.

27. Follow-up to This Session • Meeting Blog/Web Site launches on Monday • Recording of this session available • Please offer your insight and suggestions (now or later)

28. Questions/Discussion • What else can we do to make this meeting exceptional (exceptionally compelling and useful)? • What can we do to guarantee post-meeting action? • Of the potential deliverables we’ve listed, which are the most meaningful? • How can we build a sense of community among ourselves?

29. We look forward to seeing you in two weeks, and welcome your questions and feedback in the meantime…thanks!