Scaling: Let’s Not Be a One-Trick Pony

The Social Impact Exchange has an implicit model of scaling. Scaling is often discussed as replication of an intervention. That is understandable. Funders want something that is evidence-based and can be implemented without a mess. Other types of scaling, such as collective action, policy change, and systems change, are quite messy and take a long-term commitment.

The first speaker at the Social Impact Exchange conference provided a corrective to that view. Patrick McCarthy of the Annie E. Casey Foundation discussed system interventions as a way to scale.  He had five pieces of advice about how to do that.  First, you should look for the leverage points that can drive changes.  Second, you should re-imagine how to use resources in the system—do better and make it budget neutral.  Third and fourth, you should invest in systems capacity and advocacy.  Finally, you should be patient.  You will have to stick with systems change for good time.

For most of the history of the Robert Wood Johnson Foundation (RWJF) we didn’t approach scaling with replication.  We thought about developing a model, hoping that if it proved successful, the federal government would adopt it.  In 1972, the first year of RWJF, after the Department of Health, Education, and Welfare funded five emergency medical services demonstration projects, RWJF provided $15 million to expand the concept to 44 additional sites.  Ultimately, the federal government picked up funding of emergency medical services, and the idea––which we know through the “911” emergency phone number—spread throughout the country.   In the face of the early AIDS crisis, RWJF created a demonstration of health services delivery for those with AIDS in 11 cities that was modeled after an intervention in San Francisco.  Very quickly—long before the evaluation was completed—Congress adopted the model in the Ryan White Care Act.

It was almost too easy.  The scaling strategy—to paraphrase Field of Dreams—was “build it and the feds will come.”  Now when RWJF uses this approach to scaling, we realize that it won’t be as magical as it was nearly forty years ago for emergency medical systems or 20 years ago for AIDS health services.  There needs to be communication, advocacy and a campaign around the intervention as well as demonstrations and evaluations.

Patrick McCarthy sounded an important note by providing another model of scaling. I’m sure other foundations have examples of scaling in additional ways.  As we build a capital marketplace for scale, let’s not be a one-trick pony.

David C. Colby is Vice President, Research and Evaluation at the Robert Wood Johnson Foundation.

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