Collaborate to replicate Spread and scale in health care

Social franchising and licensing techniques have proven effective in replicating social projects in many sectors such as international development but they aren’t commonly used in the UK health and social care system. We believe they have potential to help systematically spread successful health and social care interventions to more patients who can benefit from interventions shown to improve patient outcomes.

Social franchising enables another team to deliver a proven intervention to agreed standards under a franchise agreement, while social licensing involves turning an innovation into intellectual property that can be licensed for use by others. To investigate these untested waters and explore these techniques, we collaborated with both Spring Impact (a consultancy who support replication of proven social impact solutions to achieve scale) and potential applicants to our new programme.

Initially we worked with health and social care teams who had tested their interventions on a small scale, but with varying experience of scaling their interventions further. They’d worked on a variety of issues such as supporting homeless patients admitted to hospital to have access to health care, and providing multi-professional maternity training to improve labour outcomes. At one day workshops with Spring Impact, 15 teams began to explore the potential of using social franchising or licensing to replicate their interventions, and answer these key questions:

• What were their goals for replication?
• What techniques could be used to support these goals?
• How does this fit in with their overall strategy?

Working with Spring Impact also gave teams a distinct perspective and framework to think about how to approach replication. For example, they considered how to identify:

• the core elements, which are critical to successful delivery of their intervention
• the flexible elements, which must be done but that could be delivered in different ways
• and the bolt-ons, which can be added to suit the local context.

It became clear that social franchising and licensing models could provide teams with the right balance of control of the core elements of their intervention, while enabling local sites to adapt as needed.

The models also seemed to provide solutions to some of the challenges faced by teams with considerable experience of spreading their intervention. For example, many teams saw a variation in patient outcomes at new sites they spread to, often finding the initial success hard to replicate.

We identified that one reason for this could be a lack of ongoing support beyond initial training – so we reviewed our initial assumptions. We realised that the teams with previous experience of implementing their intervention in different contexts, and testing and adapting it over time, may be more ready to build successful franchise or license models. We noted that:

• these teams had a strong understanding of what the core of their intervention was versus which aspects of the intervention can be flexed in local sites
• their interventions had been refined to achieve positive patient outcomes
• there was significant evidence showing that the interventions were effective and
• they had stakeholders who could enable spread regionally or nationally.

These insights fit in with our broader work to understand the journey from innovation to spreading an effective intervention across the UK and beyond. Improvement projects we’ve worked with tend to be complex interventions: highly context-sensitive, while being embedded in and influenced by organisational systems, priorities and cultures. They are also dynamic, and may evolve in different settings in different ways.

Understanding what is core to making the intervention work, and which aspects are flexible and open to adaptation, increases the chances of successful adoption. This helps teams to better spread their work.

Spring Impact have years of experience supporting projects to replicate their interventions around the world. We benefited from our close collaboration with them early on. Teams had dedicated time and expertise to support them to think about why they want to apply for our programme, before they applied. It also helped us to refine the key objectives and aims of the programme.

We have since created a new exploratory programme with four teams (from a variety of contexts) to test unfamiliar replication techniques in the UK. They will work with Spring Impact in 2018 to design, market test and develop their social franchise and license models. We’re excited to see how these develop, and how a more structured replication approach supports better care for patients, and improved health and social care for the UK population.

Read more about the teams participating in the programme

Daphne Amevenu is a Programme Manager at the Health Foundation