Care and service improvement requires the ability to make successful local change, then to transfer this for implementation in other departments and services, or across a whole organisation or sector. However, research shows that highly institutionalised and complex healthcare systems find the spread of transformation difficult, being naturally slow to adapt, innovate, and improve. Change therefore usually happens incrementally and inconsistently, with successful innovation resembling a journey rather than a single event. This is characterised by processes of adoption, implementation, sustaining, spreading, and scaling up.
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