title: Promoting development and uptake of health innovations: The Nose to Tail Tool.
abstract: Introduction Health sector management is increasingly complex as new health technologies, treatments, and innovative service delivery strategies are developed. Many of these innovations are implemented prematurely, or fail to be implemented at scale, resulting in substantial wasted resources.   Methods A scoping review was conducted to identify articles that described the scale up process conceptually or that described an instance in which a healthcare innovation was scaled up. We define scale up as the expansion and extension of delivery or access to an innovation for all end users in a jurisdiction who will benefit from it. Results Sixty nine articles were eligible for review. Frequently described stages in the innovation process and contextual issues that influence progress through each stage were mapped. 16 stages were identified: 12 deliberation and 4 action stages. Included papers suggest that innovations progress through stages of maturity and the uptake of innovation depends on the innovation aligning with the interests of 3 critical stakeholder groups (innovators, end users and the decision makers) and is also influenced by 3 broader contexts (social and physical environment, the health system, and the regulatory, political and economic environment). The 16 stages form the rows of the Nose to Tail Tool (NTT) grid and the 6 contingency factors form columns. The resulting stage-by-issue grid consists of 72 cells, each populated with cell-specific questions, prompts and considerations from the reviewed literature. Conclusion We offer a tool that helps stakeholders identify the stage of maturity of their innovation, helps facilitate deliberative discussions on the key considerations for each major stakeholder group and the major contextual barriers that the innovation faces. We believe the NTT will help to identify potential problems that the innovation will face and facilitates early modification, before large investments are made in a potentially flawed solution.
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada.
authors.forename: Archna
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Thorpe
authors.affiliation: Women's College Hospital, Toronto, ON, Canada.
authors.forename: Onil
authors.initials: O
authors.lastname: Bhattacharyya
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada.
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
keywords: Health innovation; decision makers; end users; implementation; pilot test; researchers; scale up; stakeholders