TY - JOUR T1 - Exploring the key differences between the delivery of local quality improvement projects and multisite ‘scaling up’ programmes: <em>learning from kidney services</em> JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2020-001146 VL - 10 IS - 1 SP - e001146 AU - Sonia Lee AU - Martin Wilkie Y1 - 2021/01/01 UR - http://bmjopenquality.bmj.com/content/10/1/e001146.abstract N2 - Between 2014 and 2019, four key quality improvement programmes were delivered in kidney services that required a national roll out of improvement interventions that had been developed and tested at a single site. As expected, this ‘Scaling Up’ presented a set of delivery challenges as the work was extended across multiple sites that were distinct to those seen during the local development phase. Some of these were anticipated, others were not.The programmes studied were complex interventions designed to benefit patient care and each achieved success.‘SHAREHD’ used a quality improvement collaborative to enable and increase haemodialysis self-management support across 19 National Health Service (NHS) trusts.1‘Tackling Acute Kidney Injury’ via a stepped wedge method, tested the delivery of a complex intervention at an organisational level in four locations, leading to improvements in the standards of care and patient outcomes.2‘ASSIST- CKD’ (Chronic Kidney Disease) worked with 20 sites looking to spread and sustain the use of a kidney function surveillance tool (the ‘estimated glomerular filtration rate’ graph) to identify progressive CKD earlier in primary care.3 4‘Transforming Patient participation in Chronic Kidney Disease’ established repeatable ways of working to support patients to take greater control of their health and well-being.5By presenting themes from the learning report that examined these programmes, we have explored key differences between local project development and multisite roll-out.6 This is not a structured roadmap but seeks to provide readers with significant considerations when embarking on scaling up work. We initially review themes related to the early stages of a programme and move through to implementation and execution (summarised in figure 1).Figure 1 Key points to consider when planning multisite scaling up QI programmes.Being honest about the intervention—is it ready … ER -