Live blog: Scale Up and Spread Academy


Welcome to the live event blog from Haelo’s two day Scale Up and Spread Academy, delivered in partnership with Greater Manchester Academic Health Science Network (GM AHSN) and Manchester Academic Health Science Centre (MAHSC).

Members of GMAHSN and MAHSC were offered sponsored tickets if they had graduated from an improvement programme. Participants would develop their improvement project/s during the academy to ultimately scale up and spread back in their organisation, nationally or internationally.

The two day academy will be led by national and international experts; Chief Executive of Haelo Professor Maxine PowerBrandon Bennett, Founder of Improvement Science Consulting, Director of Outhentics, Mark Outhwaite, and CEO Co-founder of Patient VoicesPip Hardy.

Today, we’ll be posting live from On the 7th, The Landing, in the heart of MediaCityUK, Salford Quays. Keep an eye on this page for updates. Already on twitter we can see our fabulous attendees gearing up for the day.

Kurt Bramfitt, Senior Improvement Advisor at Haelo, opens the academy today to our delegates. In the room we have a mix of IS4 alumni, Improving Medicines Safety (IMS) graduates among others who have completed an improvement project.

Jane Macdonald, Director of Improvement and Nursing, and Patient Safety Lead at GM AHSN, highlights the importance of spreading and scaling up our work after completing a Breakthrough Series Collaborative or improvement programme, “we’re missing something if we don’t say, and what next?” So that’s what we’ll be doing over the next two days, making sure that the valuable lessons learned and experience gained from carrying out improvement projects does not fade away. But first, to the ice breaker.

Take a look in your bag, your handbag or pocket, and pick out the most unusual item or something that has a story to tell, now share with your table.

To a story about much loved salted peanuts, a Las Vegas poker chip, a virtual reality headset, treasured family photographs to a page of quotes from Alice in Wonderland, we’re more than warmed up!

Hidden messages throughout the children’s classic tale can relate to the improvement academy today, “Imagination is the only weapon in the war against reality”.

So, why are you here today? Individuals and teams express their reasons for attending which include sharing learning, connecting and networking with like minded people, sustaining improvement and rolling out their projects to larger areas. We’ll keep these objectives around the room to inspire our work over the next two days.

Our participants have all completed, or are undergoing, an improvement project. Projects are discussed around the room to reveal what people want to gain from the academy in order support their project in the future.


We are delighted to welcome Brandon Bennett, ‎Principal Advisor, Improvement Science Consulting to present at the academy. Brandon defines the difference between spread and scale: spread = the movement toward implementation of solution within a single system or organisation from it’s initial point of innovation or adoption. Scale = the adoption of solution across multiple systems, organisations or locations.

Methods for spreading changes are outlined, with examples listed and referenced in resources below:

Teams are now working through ideas for gaining commitment for change.


Next up, Professor Maxine Power, Chief Executive, Haelo and Clinical Lead, MAHSC, discusses overcoming challenges to improving quality. Referring to a paper on overcoming challenges by Mary Dixon Wood, Maxine emphasises that convincing people that there is a problem and getting them on side is something that you should not underestimate. To do that, you will need evidence and that means data.

We are delighted to now welcome Pip Hardy, co-founder director of Pilgrim Projects, an education consultancy specialising in healthcare quality improvement. Pip along with Tony Sumner established the Patient Voices Programme to communicate patients’, carers’ and clinicians’ experiences to designers and deliverers of healthcare, and to support and enrich the development of ‘delightful’ learning.

Pip presents on the topic of convincing people that there is a problem and the importance of patient stories. Stories can provoke empathy and a call to action. A few questions:

  • Is it reasonable to expect patients to share (often painful) stories in person?
  • Should they be paid? If so, how much?
  • Will they lose their benefits?
  • How can we be sure they are telling the story they want to tell?
  • How can we protect their rights and their story?
  • How can we support them?

A powerful and moving film, Jimmy’s Story,  is presented to the room. A patient’s fall in hospital goes unobserved and unrecorded and leads to a severe spinal injury. Would earlier and more appropriate intervention have led to a different outcome? Watch here. The next patient story, Getting to the bottom of things told by Jean Bailey Dering, is presented to the room.

Following both films, the room is asked to think about the reflective model; EAR.

  • Effective – What did you think?
  • Affective – What did you feel?
  • Reflective – What will you do?

Now back to Prof Maxine Power, who shares her personal experience with the healthcare system and the memories that have stuck with her ten years on. A deep personal experience inspired Maxine to do the work that she now does in improvement, and how the next decade of her life following this experience was dedicated to developing the skills to be a part of the improvement community, to make a real difference and incite change.

The power and influence in our ability to tell stories, use digital platforms and each other is growing. Maxine tasks the room to get in groups of two, ten minutes each, to tell their own experiences based on three words: self, us and now.

Telling your public story, by Marshall Ganz, explains how stories not only teach us how to act – they inspire us to act. Stories communicate our values through the language of the heart, our emotions. And it is what we feel – our hopes, our cares, our obligations – not simply what we know that can inspire us with the courage to act. Continue reading.

Maxine addresses concerns that some delegates felt vulnerable sharing and sometimes uncomfortable talking so personally, they are encouraged to practice their story. Practice will help to evolve their story and build their resilience so it becomes easier to share. Jane Macdonald recommends a TED Talk by Brene Brown on the power of vulnerability.

Break for lunch…

Back and refreshed from lunch, we open for the afternoon with Brandon Bennett who begins with, what does success look like?

The story is of large scale change, about an organisation called BRAC, the largest non profit, non government organisation in the world. Bangladesh Rural Advancement Committee (BRAC) works to empower rural Bangladesh communities with the oral rehydration therapy that saves many lives from fatal dehydration due to diarrhea diseases, almost eliminating cholera deaths in Bangladesh.

This spectacular story revolved around the production of materials; by mobilising community health workers to go into communities with a picture story book that told an illiterate community how take medicines.

Now to the final section this afternoon, planning your large scale change.

Delegates have all been involved in an improvement programmes and are therefore familiar with Demming’s System of Profound Knowledge and the four areas: appreciation for a system, knowledge of variation, theory of knowledge and psychology.

Brandon presents four challenges in the design and planning stage, these include:

  1. Convincing people there is a problem
  2. Convincing people that the solution chosen is the right one
  3. Getting data collection and monitoring systems right
  4. Excess ambitions and “projectness”

Participants are asked to examine their project and review each challenge in turn.

Participants are made aware of reactions to change:

  • Resistance: an emotional or behavioral response to real or imagined threats to the work routine
  • Apathy: feeling or showing little or no interest
  • Compliance: publicly acting in accord with social pressure while privately disagreeing
  • Conformance: a chance in behavior or belief as a result of real or imagined group pressure
  • Commitment: the state of being bound emotionally or intellectually to a course of action

How we can move people towards commitment and combat the above actions. Brandon lists five actions to assist commitment as:

  • Create the will
  • Provide information on why
  • Provide information on how
  • Get consensus on the resources
  • Publicise the change

And that brings day one to a close. Check back in for updates live from day two tomorrow.

Welcome to day 2 of #ScaleUp and Spread! We will be live blogging the whole day so keep checking for updates. Also join in the conversation on Twitter using #ScaleUp

Our Senior Improvement Advisor, Kurt Bramfitt, summarises the topics discussed at day 1 including design and planning, types of framework to use, common challenges to overcome, how to convince publics there is a problem using varied methods and how to convince publics that a solution is preferable through data.

Our first session is from Mark Outhwaite, Owner and Director of Outhentics who presents on experiences, challenges and successes of managing large scale change.

Mark takes a honest look at the complex issue of scaling up using personal insights and real world examples. Mark introduces the concept of the mental model of change and confirmation bias. Mark implores that we all have a different mental model of change and that his way of implementing large scale change is ‘not the truth, not only way of doing it, it’s my bee in my bonnet.’ He believes that the mental model of change is ‘fundamental to scale up and spread.’ Mark also commented on the influence of leadership and culture on personal mental model of change of which he believes performance management has become prevalent ad ‘invaded’ the model.

Confirmation Bias is ‘screening out stuff you don’t agree with, screen in favourable changes.’  The tendency to interpret new evidence as confirmation of one’s existing beliefs or theories. Mark accepts that confirmation bias exists but can be overcome.

Mark continues discussing the approach to scaling up with an analysis of Optimism Bias. He uses his own example of the redesign of an emergency pathway of which he states the biggest lesson he learnt was how to fail better. ‘Fail fast, fail forward.’ This mindset is integral to optimism bias as there needs to be an acceptance right at the beginning of project that you will fail but you will learn.

Mark Outhwaites Top Tips
Slides available in Resources below

  1. The Premortem
  2. Take back control of your time
    Use a methodology such as Productive Leader with your team and be the change you want to see in others
  3. Take the right people on the journey with you from the start
    Engage in co-design and co-production from the very start through to the end and beyond – and keep them connected
  4. Map the networks and use the connections
    Take time to understand the ‘ties that bind’ and use them. Spot where there are gaps that need to be bridged. Build coalitions
  5. Keep the roadmap simple, keep it visual
    Get your plan on one side of A3 – a project charter with a driver diagram works well. Nobody who matters has the time to read any more
  6. Programmes have rhythm
    Your change programmes need a regular rhythm to give energy and focus to scaling and spread
  7. Systematically build improvement capability and capacity
    Be absolutely rigorous in developing, embedding and sustaining improvement capabilities throughout the system

Top Tip for Leaders

  • You need to ask yourself how you are going to be the change you want to see in others and be brave enough to give it a go and share your learning openly


Back from the break, Brandon Bennett, Improvement Advisor and Consultant, begins the second session Data Collection and monitoring systems for scale. He starts by posing the question how do we measure the content? The Measurement Tree is a logical framework that builds links between outcomes. Measures include; outcomes, processes, balances. Brandon then leads several breakout sessions which tackle content specific data, team engagement data and network health data.

Brandon now talks of the ‘incredible value of small multiples.’ Small multiples allow you to see the overall performance of the project along side the performance of individual sites, easily directs attention toward sites that are doing particularly well, and sites that are stagnant, getting worse, or are now yet reporting data, acts as a management aid in assigning resources to sites based on observed need.

Break for lunch…

We’re back in the room with our Chief Executive Professor Maxine Power who is speaking this afternoon on overcoming #tribalism and poor #staff engagement; including understanding the psychology of change, identifying early adopters and harnessing commitment through incentives.

Maxine begins by entertaining the room recounting her professional background. Maxine describes how her time at the Department of Health was at the very point of major policy changes providing a contextual parallel between her improvement background and the improvement journeys that the delegates are on. ‘You have to have confidence in your abilities to lead and take people with you.’

Maxine talks through the harm improvement programmes she has been involved in including Harm Free Care and the NHS Safety Thermometer of which Maxine describes as an ‘enduring presence in the NHS’ as it originally was only a year long programme. Brand building and legacy are important factors in your improvement journey to ensure that the programme has long lasting effects and can be scaled up and spread and therefore be incorporated into policy / accepted as the norm.

Using understanding organisational context when implementing large scale change is vitally important. Knowing where the challenges are and dealing with them proactively as you go along is the path for the future. Jane Macdonald joins in the conversation and reinforces Maxines sentiment of ‘doing a sense check first.’ There are standardised tools including; MaPSaF (Manchester Patient Safety Framework) and MUSIQ (The Model for Understanding Success in Quality).

With a room discussion on tribalism underway, delegates are inputting their opinions and experiences of tribalism and the barriers faced with implementing large scale change which include excuse bingo!


An antidote is to gain peoples trust and confidence. Maxine believes that the Model of Improvement is the tool to combat tribalism and celebrating success and intrinsic motivation are essential components to harnessing commitment. ‘Take people on the journey with you!’

After a short comfort break, we are back with the six teams present reporting on their improvement project and how Scale Up and Spread has impacted on their journey going forward; Sheffield Teaching Hospitals NHS Foundation Trust, Salford Royal NHS Foundation TrustEast Lancashire Hospitals NHS TrustLeeds Teaching Hospitals NHS Trust, Central Manchester University Hospitals NHS Foundation Trust, Haelo Clinical Fellow programme, Manchester Mental Health and Social Care Trust and Greater Manchester Academic Health Science Network.

That is almost it! It’s been a fantastic event. There will be a Scale Up and Spread Webinar clinic on the 20th February.

Keep in touch with Haelo by downloading the Haelo Event App, find out more information here.
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Access the full Prezi, including slides from Brandon Bennett here.

Brandon Bennett references:

Mark Outhwaite

Prof Maxine Power references:

Pip Hardy references:

Other recommendations include:

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