This Evidence Check review and summary report examined the evidence for successful and sustainable large-scale change in complex health systems. Thirteen key factors were identified as vital to the success and sustainability of the change initiatives and are categorised as factors relating to preparing for change, to the process of change, and to preparing for sustainability. The importance of balancing centralised planning and coordination with local level autonomy and the value of a system perspective were highlighted. The difficulty of rigorously evaluating large-scale change in complex health systems was also noted.


Atkinson J, Patel C, Wilson A, Mittman B, Dominello A, Brown B.

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