Change is scaled up, scaled out, or scaled deep

Change is scaled up, scaled out or scaled deep

Outcomes of social movements can vary; when effective, they can be scaled up, scaled out, or scaled deep to further the spread and influence of the change. In this section, you will learn about the concepts of scaling up, scaling out, and scaling deep, and what it takes for change agents to scale change.

What is the outcome ‘Change scaled up, scaled out, or scaled deep’?

A social movement can achieve and sustain change when planning, momentum and energy are present. When social movements for evidence-informed practices, they may be spread to widen their impact, access and influence, and maximize implementation efforts and health outcomes. This spread can occur on a continuum of scaling up or scaling out; it can also be scaled deep resulting in transformed values and norms.  

Scaling up involves expanding coverage and uptake for a change initiative. The change initiative is delivered in the same way, but to a different population and/or in a different setting. For example, a change initiative designed for one setting (e.g., a public mental health clinic) is scaled up to other settings that are the same or similar (e.g., a roll-out to all public mental health clinics in a province). Policymakers and change teams assume that outcomes are similar across these sites as long as the change is rolled out in the same way as the first site that adopted the change.

To scale up and support wide dissemination, the goals and vision of the social movement must be framed to context and understood by change agents and other stakeholders. Examples of scaled-up programs using social movement actions are evident in many sectors including public health, such as initiatives targeting heart health promotion, childhood obesity prevention and workplace safety

SOURCES: Edwards, 2010; Grinspun, 2018a.

Scaling out is an extension of scaling up to standardize the change. The change is delivered to new populations and/or through new delivery systems that are different from the original population(s) and/or setting(s). For example, when an acute care center scales out in-person smoking cessation groups to adults, the following may occur:

a) a new delivery system is used with the same population (e.g., virtual care for adults),

b) the same delivery system is used with a new population (e.g., in-person groups for seniors), or

c) a new delivery system is used with a new population (e.g., virtual groups with seniors).

Through scaling out, the spread of the change initiative (e.g., an evidence-based program) is further widened to broaden its delivery and impact.


Accelerate Your Success: The Knowledge-to-Action Framework’s ‘Evaluate outcomes’ action cycle phase includes types of measures to determine if an innovation is successful or effective. Any change that is being scaled up, scaled out, or scaled deep must demonstrate impact and create solutions or enhancements to a shared concern or strongly desired change. It can be helpful for change agents to use evaluation metrics such as indicators to determine the effect and power of a change. 

Scaling deep occurs when the norms and values change. When change is scaled deep, it transforms how individuals, groups and organizations think about the concerns or issues and creates lasting cultural shifts that become widely accepted, sustained and standardized. To scale deep, the change must be deeply rooted in people and their relationships, communities and cultures. Scaling deep can occur at the micro level (i.e., at the point-of-care), at the meso level (i.e., within one or more settings or across an organization), and/or at the macro level (i.e., in health systems in which they are transformed, often as the result of applying evidence, strategic advocacy and healthy public policy initiatives). 

SOURCES: Aarons et al., 2017; Grinspun, 2018; Grinspun et al., 2018a; Moore et al., 2015.

Why is the outcome ‘Change scaled up, scaled out, or scaled deep’ important?

  • Scaling up, scaling out, or scaling deep may lead to a new iteration or wave of a social movement, triggering renewed action. This new iteration may be shaped by the successes and/or challenges of the previous social movement or from periods of collective action and renewed interest by former and/or new change agents.   
  • When a change gets integrated into the fabric of the organization, it gets transformed and becomes scaled deep as the new norm. This can spark another wave of the social movement or catalyze a new one (del Castillo et al., 2016; Grinspun et al., 2018a).