Scaling up – Integration and Implementation Insights

An approach for operationalizing and sustaining systems improvements

March 25, 2025

By Dintle Molosiwa.

How can we develop more effective interventions that address root causes of insufficient system performance? How can systems-informed interventions achieve and sustain more impactful system improvements? What strategies ensure multisectoral collaboration in systems improvement initiatives?

This i2Insights contribution is based on experience in improving health systems in South Africa, Senegal, Zambia, Botswana and Chemonics global health supply chain portfolio, but is likely to have wider relevance for other systems and countries.

Colleagues and I (Chemonics Health Practice and SYSTAC Africa Hub, 2024) distilled existing system thinking frameworks into a four-step cycle: examine; co-create; implement and adapt; and adopt and scale.

Diffusion of innovations

August 1, 2023August 1, 2023

By James W. Dearing

james_dearing — James W. Dearing (biography)

How—and why—do people decide to try new things?

Studies of diffusion have frequently demonstrated a mathematically consistent sigmoid pattern (the S-shaped curve, see figure below) of over-time adoption for innovations. Innovations include new beliefs, practices, programs, policies, and technologies.

The “S” shape is due to the positive engagement of informal opinion leaders in talking about and modeling an innovation for others to hear about and see. The initial slow rate of adoption gives way to a rapidly accelerating rate, which then slows as fewer non-adopters remain. Alternatively and more commonly, when informally influential people do not get positively engaged or when they ignore or actively reject an innovation, diffusion does not occur and the resulting slope of a cumulative curve stays flat or turns negative.

How can we amplify impact to foster transformative change?

January 18, 2023September 29, 2020

By David P. M. Lam

author-david-lam — David P. M. Lam (biography)

How can the impact of sustainability and other initiatives be scaled or amplified to achieve transformative change?

There are hundreds of promising sustainability initiatives emerging around the world. A sustainability initiative is, for example, a local food initiative from citizens and farmers who promote healthy and organic food production and consumption. Another example is the installation of solar panels by a community to support the use of renewable energies. Such initiatives provide potential solutions for urgent sustainability problems, for instance, biodiversity loss, climate change, social injustice, and poverty in rural areas or cities.

This blog post is based on a review of the literature to understand how sustainability transformations research is currently conceptualizing the scaling or amplifying of impact from initiatives.

Four best practices for scaling up effective innovations

November 20, 2025August 8, 2017

By Amanda Fixsen, Karen Blase and Dean Fixsen

authors_amanda-fixsen_karen-blase_dean-fixsen — 1. Amanda Fixsen (biography)
2. Karen Blase (biography)
3. Dean Fixsen (biography)

What is involved in effective scaling up of innovations in order to achieve social impact? Here are four best practices, drawn from our experience in scaling up human services innovations and programs for children and families. We also provide definitions of the key terms used.

1. Understand the target audiences

Effectively scaling innovations first requires attention to defining the denominator, or population of interest for the scale-up effort, as well as the numerator, or the number of children and families who are receiving the innovation with fidelity and good outcomes.

2. Purposeful design leads to high-fidelity use

Scaling up amidst complexity

October 9, 2025June 27, 2017

By Ann Larson

How can new or under-utilized healthcare practices be expanded and institutionalized to achieve audacious and diverse global health outcomes, ranging from eliminating polio to reversing the rise in non-communicable diseases? How can complex adaptive systems with diverse components and actors interacting in multiple ways with each other and the external environment best be dealt with? What makes for an effective scale-up effort?

Four in-depth case studies of scale-up efforts were used to explore if there were different pathways to positively change a complex adaptive system.

A primer on policy entrepreneurs

November 20, 2025April 18, 2017

By Jo Luetjens

In the world of public policy, it is interesting to consider how and why particular policy ideas catch on. What is it that makes some ideas succeed and others fail? By examining the role of policy entrepreneurs we may come closer to an answer. In making policy change happen, what – and who – are policy entrepreneurs? Why are they important? What strategies do they use to effect change? And finally, what are the attributes of a successful policy entrepreneur?

The what

Policy entrepreneurs are energetic people who work with others in and around policymaking venues to promote significant policy change.