Evidencing Impact of Large-scale Health System Transformation: Introducing the ‘shift’ Framework

This paper describes the development of a single impact framework influenced by Best et al’s ‘simple rules’ for large scale system transformation and the subsequent mechanism that change can be scaled up from proof of concept across pilot projects [1]. The new framework aims to 1) enable evidence of impact from large-scale transformation across different practice contexts and system levels, from micro to macro level; and 2) identify building blocks for evaluating the progress of Integrated care systems and sustainable transformation for quality healthcare, experienced as person-centred, safe and effective with continuity across communities.A meta-analysis of 46 practice development projects completed over 12 years using three phases of analysis synthesized into a single impact frameworkThe Sustainable Health and Care Innovation for Future Transformation (SHIFT) framework has five overarching themes; three focus on integrated care systems; and two on workforce transformation, as interdependent requirements for sustainable transformation.The results reflect a radical shift required in paradigms, systems and workforcecapacity and capability necessary to drive sustainable transformation at a societal level.The SHIFT framework can be used to identify essential building blocks fortransformation and associated sustainable impacts; to clarify and support ongoing research and evaluation activity. By distinguishing the kinds of changes that embedded research and practice development enables as an informed appreciation of how blended scholarship (encompassing learning, knowledge translation, embedded research, quality and service improvement and evaluation) contributes to change, incorporating all those who engage in the process of change across whole systems and at different levels.