Transformation Approach: Scale

Having evidenced the value of your new approach, and gained support and investment from stakeholders, you can start to consider how you might scale your activity.

Scaling up vs Scaling out ​ There are a number of interpretations of the terms scale up and scale out. In this instance we will use the terms as follows:​ ​

• Scale out– Scaling “out” is the expansion of an existing model or approach so that it reaches more people or regions. It can also include development of new activity to improve outcomes for the same beneficiaries. The replication of a successful return to work program across many different geographies is an example of scaling out​. To scale out, you will need to revisit your logic model in terms of the activities, inputs and outputs required to achieve your revised outcomes. You will also need to re-consider your service design in terms of increased scale and the need for more or different resources.
• Scale up– creating a system change by increasing activity to a policy level. Systemic Change involves the modification of rules or behaviours in the wider system to reduce the problem or make it easier to address.​ ​ Scaling up often focuses on the root causes of problems by directing efforts towards changing the whole system including conditions and behaviours from which the problem arises. This can take the form of a preventative approach where early intervention is the focus. For instance, programmes which aim to utilise the skills of older people may scale up impact by trying to change the perception of the elderly from dependants to contributors. To scale up you will need to reframe the problem. Scaling up requires the ability not only to understand the problem from a system perspective, but also the ability to influence rather than directly controlling the system. This becomes a truly collaborative effort where different impacts may be anticipated from those expected from a programme designed to address issues rather than reduce them.

Scaling up or out needs to be an intention of your work from the start – transformation of public services is to change the system, not just to introduce a pilot. So the approach from inception needs to reflect the aim to move from initial prototype phase to a sustained system change. Developing and implementing a programme at scale can be a complex process which requires organisations and partners to embrace an entirely new approaches, business models and ways of working.

This does not mean that every transformation needs to operate at a grand scale, but that it will almost certainly need to be at a broader scale than your initial test-beds / prototypes; and will require a sustainable model for funding and operation, to deliver the impacts on outcomes you want to achieve.​ ​ The initial investment in a prototype should be relatively straight-forward – on the basis of a business case around a proposition you wish to test. Historically much of this activity has been funded through grants to undertake pilots. However, rarely have they been sustained.​

To scale out or up requires the development of a specific business case around larger scale, longer term investment. This will require ‘deals’ to be struck locally (and potentially with national and other partners) to provide collective funding. You will need to understand the outcomes you expect to change, and impact of your proposed actions on those outcomes. This will mean you need to bring your evidence and experience from prototyping your approaches to support your case for long term investment.​

You will need to understand the payback that should flow from these investments, and how that payback can be realised. See Invest for more information on the development of a business case to secure investment – see Invest.

It may be necessary to scale out an approach before it can be scaled up. This helps provide the evidence, knowledge and experience needed to understand what needs to happen to scale up and create a movement towards systemic change. Scaling out also provides an opportunity to develop relationships with partners so that collaborative leadership is at a mature enough level to progress to scaling up.​ ​ Both scaling out and scaling up are positive actions in pursuit of service improvement and savings, however fiscal benefits may be greater with a systemic change.

You must complete this work before you can:

• ​Deliver a test of your service model​
• Assess its effectiveness against predicted costs and benefits​
• Demonstrate that the transformed service model has greater value than the existing model or if it is a new model, demonstrate that it is likely to deliver the anticipated outcomes.

Key Activities

Identify opportunities to scale up/out and review your benefits realisation approach

1. You will need to understand right scale of action, whether to scale out or scale up – both to generate the outcomes you want to achieve, to design your wider implementation, and to understand your investment needs. You will need to understand the economies of scale potential, vs the “low hanging fruit”.
2. Understanding the benefits, where they fall in the system, and how you will realise them is key to scaling your investment in transformation. You should learn from your prototype work and your initial test implementation to support this. However, you may still need to rely on some modelling, as benefits may only be realisable (in terms of cash savings resulting from improved outcomes) when delivered in sufficient concentration or scale. You will need continued collaboration between partners – at all levels – to capture (and therefore gain) from these benefits. ​

Service design – delivering at scale

1. You will have done much of the service design work you need to do during your Define and Prototype phases. However, delivering at scale, and in a sustained way, may require further service redesign.​
2. You may need to return to your service design, evaluation approach and benefits realisation models to define further arrangements needed for the scaling up of your approach ie ​ partner roles and responsibilities (including community), ​ funding longevity, ​ disinvestment from existing service​ Workforce arrangements, estates, IT equipment etc​
3. This stage could include consideration of new forms of delivery organisations, with implications for workforce, along with joint commissioning approaches across your place.

​Developing an investable proposition will only be possible when stakeholders have agreed previously the type and amount of evidence of success they are expecting to see.

Actions

Important actions for the Scale phase are:

• Use the evidence gathered throughout the programme to demonstrate the value of your new approach.
• Identify opportunities to scale out or scale up: With your partners, consider how you might scale your approach

Originally published 03 AUGUST 2015  Author: Helen Nicol

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