Mobilising knowledge to assess the potential for scaling up a health and social services innovation in 5 phases

📜🔗LINK to the source

1. Analytical summary

Context, audiences and issues

The report is part of the mission of the SSA Support Unit Québec to support a learning health system through the implementation of changes and continuous quality improvement, with a strong requirement for knowledge mobilisation. It is based on an innovation developed at GMF‑U La Pommeraie (2018–2022) aimed at reducing errors in receiving laboratory and imaging results, a major issue in a context where approximately 40% of primary care consultations end with the prescription of a test. The innovation combines the mobilisation of multiple stakeholders, technological adjustments, and active monitoring of incidents to secure the flow of results. The MOBILISER project seeks to describe this innovation, document the mobilisation of actors, and evaluate, via the ISSaQ 4.0 tool, its potential for scaling up to other GMF‑U, relying on a concrete case of recruiting a new environment (GMF‑U Saint‑François‑d’Assise). The target audiences are quality management teams, clinical leaders, system improvement researchers, and structures wishing to extend an innovation while considering local realities.

Operational contributions for the actors

The document describes a five-phase methodology: project planning, detailed description of the innovation using TIDieR, recruitment of new settings, contextualised knowledge mobilisation, and then evaluation of scalability with ISSaQ 4.0, including an adaptation in Excel format and a mixed quantitative-qualitative analysis. It provides concrete tools: project charter, agenda template, TIDieR-based questionnaire, stakeholder mobilisation guide inspired by the RENARD team guides, operational indicators to track outcome incidents, and Excel format of ISSaQ 4.0 with automated visuals. The results detail the mobilisation process in the recruited GMF-U (emails, meetings, co-development of materials, presentation to CLACQ, adaptation of the monitoring process and construction of indicators) and the scalability scores by ISSaQ component, allowing the identification of strengths and weaknesses (costs, sustainability, EDI, patient mobilisation). The lessons learned synthesise the key points: knowledge mobilisation as a continuous process, the necessity of a deep understanding of the innovation, the requirement for the recruitment of settings, and the role of ISSaQ as a "mirror" of the blind spots before scaling.

2. Key points of the document 

1. Structured knowledge mobilisation in five phases (p. 3, 10–12, 24)

   The report formalises a complete process of knowledge mobilisation, from planning to scalability evaluation, illustrated by figures 1 and 3. It details the sequence: co-construction of the charter, documentation of the innovation, recruitment, contextualised mobilisation, and use of ISSaQ 4.0, with monthly meetings ensuring continuous adjustment.

2. Detailed description of the secure results tracking innovation (p. 12–13, 41–44)

   The innovation "A process for the secure tracking of laboratory and imaging test results" is described based on a literature review, TIDieR, and consultations with the innovators, clearly distinguishing the intervention from the implementation strategies. The report details the audit of issues, the mapping of the process, the co-construction of solutions with stakeholders (clinicians, administrative staff, partner patients), and the monitoring by performance indicators.

3. Recruitment of settings and engagement funnel (p. 14, 27)

   Of the 54 ACQ community member settings contacted, only 4 express interest and 1 is ultimately recruited (GMF-U Saint-François-d’Assise), illustrating the demanding nature of recruitment for scaling up. The flow diagram (Figure 5) highlights the steps and dropouts, providing valuable feedback on organisational and timing obstacles.

4. Reusable knowledge mobilisation tools (p. 16–23, 38–48)

   The report provides concrete supports: simplified summary for the settings, co-developed PowerPoint presentation, agenda template, innovation description guide (based on TIDieR), and list of indicators to track incidents in the electronic system. These tools, listed in the appendices (charter, questionnaires, ISSaQ Excel formats), are directly replicable or adaptable by ACQ teams or quality departments.

5. Assessment of scalability with ISSaQ 4.0 and detailed analysis (p. 7–9, 24–31, 69)

   The authors adapt the ISSaQ 4.0 questionnaire (12 components, 37 statements) into an Excel format with automated calculations and visuals, then have it completed by four profiles of evaluators (ACQ agent, innovator, member of the SSA team, regional ACQ agent). The average scores show a favourable political context, an implementation environment, and potential coverage, but weaknesses in costs, sustainability, EDI, and the mobilisation of targeted populations, supported by a thematic analysis of the comments.

3. Action points for local stakeholders 

1. Structure your scaling-up projects in five phases (p. 3, 10–12, 24)

   Draw inspiration from the proposed sequence (planning, description of the innovation, recruitment of environments, contextualised mobilisation, evaluation of scaling-up potential) to structure any project for extending a clinical or social innovation. Formalise a project charter, a diverse steering committee, and an action plan from the outset, as described in phase 1.

2. Use TIDieR and a structured questionnaire to describe your innovations (p. 4–5, 12–13, 41–44)

   Use the adapted TIDieR questionnaire (Appendix 3) to describe, in your contexts, the intervention, its essential components, its implementation modalities, its adaptations, and its key actors. This step allows for a clear distinction between what belongs to the 'core' of the innovation and what pertains to the context, facilitating adaptation during scaling-up.

3. Plan a gradual mobilisation of environments and accept the funnel (p. 14–16, 27–29)

   Anticipate a low conversion rate between contacted environments and those actually engaged, as shown by the shift from 54 to 1 GMF-U recruited. Use a progressive strategy: initial email, simplified summary, first exploratory meeting, co-construction of materials for internal committees (type CLACQ), then formal decision in existing bodies rather than creating new engagement procedures.

4. Co-construct local indicators for tracking results (p. 21–23)

   Rely on the proposed list of indicators (drafting requests, electronic transmission, conducting the review, issuance, routing, filing, informing the prescriber, signing, supervision, patient information and follow-up) to build or adapt a local incident dashboard. Integrate these indicators into the information system and provide a reporting and analysis procedure, in line with continuous quality improvement practices.

5. Test scalability with ISSaQ 4.0 before massively expanding (p. 7–9, 24–31, 69)

   Use ISSaQ 4.0 (French or English version) to assess the scaling potential of your innovations, involving various evaluator profiles (field, innovation, regional management, research). Rely on the weakest components (costs, sustainability, EDI, mobilization of targeted populations) to define an improvement plan before aiming for larger-scale deployment.

4. Additional references 

• Experiences and perceptions of scaling a public health intervention: interviews with a variety of French stakeholders - https://www.pratiquesensante.com/blog/pratiques-15/experiences-et-perceptions-de-la-mise-a-l-echelle-d-une-intervention-de-sante-publique-entretiens-aupres-d-une-variete-d-acteurs-francais-5888
• Strategies for scaling health and social service innovations: knowledge and tools drawn from nine concrete Quebec cases - https://www.pratiquesensante.com/blog/pratiques-15/strategies-de-mise-a-l-echelle-d-innovations-en-sante-et-service-sociaux-connaissances-et-outils-tires-de-neuf-cas-concrets-quebecois-4515

Others

1. Corôa F, Légaré F et al. « Innovation Scalability Self‑Administered Questionnaire (ISSaQ 4.0) – English Version Guide », SSA Québec, 2024.

   Comprehensive methodological guide for the use of ISSaQ 4.0, useful for teams wishing to replicate the scalability assessment approach. https://ssaquebec.ca/wp-content/uploads/2024/09/Outil_Guide_ISSaQ-4.0__english_version.pdf

2. CRESEB. « Knowledge Transfer Plan – Methodological Guide », 2024.

   This guide provides a detailed framework for designing, planning, and evaluating knowledge transfer/mobilisation plans, complementary to the MOBILISER approach for public health or medico-social projects. https://www.creseb.fr/voy_content/uploads/2025/03/2024-Creseb-PlanTransfertConnaissances-VF.pdf

5. Frequently Asked Questions (FAQ) 

1. How does this report define knowledge mobilisation? (p. 1–2, 10–11, 33–35)

   The report reiterates the definition from the CIHR as a set of activities for synthesis, dissemination, transfer, exchange, co-creation, and co-production of knowledge between researchers and users, and illustrates it through a five-phase process applied to a clinical innovation. It emphasises the continuous, iterative, and participatory dimension of mobilisation, rather than on one-off actions.

2. What concrete clinical problem is addressed by the innovation? (p. 1–2, 12–13, 28–30)

   Innovation aims to reduce errors in receiving and managing laboratory and imaging test results, which are potential sources of diagnostic delays, adverse events, and medico-legal risks. It covers the entire chain: drafting the request, transmission, execution, issuance, delivery, filing in the record, informing the prescriber, informing the patient, and follow-up.

3. How does the report propose to describe an innovation before scaling it up? (p. 4–5, 12–13, 41–44)

   It recommends using a TIDieR-based questionnaire to specify the "what", "why", "who", "how", "where", "when and how much", as well as the adaptations and fidelity of the intervention. This description is supplemented by a literature review (scientific article, training material) and regular consultations with the innovative team.

4. What does the experience of recruiting new settings show? (p. 14, 27)

   Out of 54 ACQ community settings contacted, 4 express interest and 1 is recruited, confirming a significant recruitment funnel for scaling projects. The authors highlight the importance of timing, mobilising existing networks, and raising awareness among clinical management and internal committees.

5. How is ISSaQ 4.0 used in this project? (p. 7–9, 20–21, 24–31)

   The ISSaQ 4.0 is presented, adapted into Excel format, and then filled out by four types of evaluators to assess 12 components of scalability, with scores from 1 to 7 and qualitative comments. The results are synthesised into tables and figures, allowing for visualisation of score profiles by component and by type of evaluator, and identifying strengths and areas of fragility.

6. What are the main strengths and limitations identified for scaling up? (p. 35–36, 28–31, 69–70)

   The strengths: relevance of the problem, demonstrated effectiveness in the pilot setting, political alignment, acceptability, and similarity of settings (GMF-U). The limitations: lack of cost and cost-effectiveness data, insufficiently planned sustainability, partial engagement of targeted populations, and limited integration of equity, diversity, and inclusion issues.

7. What general lessons does the document propose for other teams? (p. x–xii, 33–36)

   The lessons learned emphasise knowledge mobilisation as a continuous process, the need for a nuanced understanding of the innovation before scaling up, the difficulty of recruiting new settings, and the value of co-development for ownership. The ISSaQ 4.0 is presented as a structuring tool that highlights strengths, but also areas of concern to address before a wider deployment.

6. Rewriting in Plain Language 

Plain Language Title

Implementing a health innovation in multiple locations

with the help of an ISSaQ 4.0 questionnaire.

Context – Plain Language

• A team has created a new way to track examination results.

• This method reduces errors and delays in results.

• The team wants to use this innovation in other clinics.

• The report explains how to properly prepare for this change.

Method – Plain Language

• First, the team describes the innovation with a simple guide (TIDieR).

• Then, it looks for interested clinics to test the innovation.

• Then, she organises meetings with the teams from these clinics.

• Together, they adapt the innovation to the local context.

• Finally, they complete the ISSaQ 4.0 questionnaire to see if the innovation can be extended.

Results – FALC

• 54 environments were contacted, 4 were interested, 1 was recruited.

• With this environment, the team reviewed the steps for tracking results.

• They created a list of indicators to identify errors in results.

• The ISSaQ questionnaire shows strengths for the context and acceptance.

• It also shows weaknesses regarding costs and duration over time.

Key lessons – FALC

• Knowledge mobilisation is a long and ongoing process.

• It is important to fully understand the innovation before disseminating it more widely.

• It is difficult to find environments willing to engage.

• Working together on tools and indicators helps with ownership.

• The ISSaQ questionnaire helps to see what is ready and what is lacking.

7. Cross-sectional analysis – Values of health practices

• Literacy: The document provides a simplified summary for environments and emphasises the use of accessible language in presenting the innovation, but does not develop a systematic health literacy strategy for all audiences.

• Empowerment: The beneficiaries (patients) are present through public representatives at the CLACQ, but their involvement in design and evaluation remains limited compared to that of professionals.

• Participation: The report describes several co-construction mechanisms (co-development of presentations, co-elaboration of indicators, steering committee, CLACQ), mainly focused on professionals and managers.

• Community health: The collective dimension is taken into account through the GMF-U, the ACQ community, and multi-actor partnerships, but the anchoring in the community in the broad sense remains poorly detailed.

• Ethics: Cultural or social biases are little analysed, and the dimensions of sex/gender, indigenous communities, and visible minorities are mentioned in ISSaQ but poorly documented in the case studied.

• Human rights: The approach aims to be fair and inclusive through certain ISSaQ components, but the report acknowledges that equity, diversity, and inclusion are not yet explicitly and systematically integrated.

• Intersectorality: Partnerships mainly rely on the care network, universities, research centres, and the SSA support unit; links with other sectors (social, community) are poorly detailed.

• Partnership: A model of formalised collaboration appears through the project charter, the steering committee, the CLACQ, and the commitment of the GMF-U, with an important role for partner citizens.

• Combating discrimination: The document mentions EDI in ISSaQ but acknowledges a lack of explicit integration of these dimensions; potential discriminations are not explored in the case studied.

8. Evaluation of the reliability of the resource

• Scientific relevance

  The report is based on a structured methodology (TIDieR, ISSaQ 4.0, literature review, thematic analysis), an explicit conceptual framework for scaling up, and recent references on knowledge mobilisation. The data is described transparently (recruitment procedure, mobilisation script, detailed scores, acknowledged limitations), which provides good scientific robustness for an applied project report.

• Operational relevance

  The resource is very operational: step-by-step description of the phases, concrete tools (charter, questionnaires, indicators, Excel formats), real case of GMF-U, analysis of strengths/limitations and transferable lessons. It is directly useful for quality actors, project managers, and organisations wishing to deploy an innovation, provided that the content is adapted to local legal and organisational contexts (France, other countries).