1. CLAHRC for South Yorkshire Collaborations for Leadership in Applied Health Research and Care for South Yorkshire (CLAHRC SY). www.clahrc-sy.nihr.ac.ukwww.clahrc-sy.nihr.ac.uk Innovation in the sustainability and spread of behavioural change: lessons from the NIHR CLAHRC for South Yorkshire, UK Kate Gerrish, Ann McDonnell, Kate Bray, Irene Ilott, Sara Laker kate.gerrish@sheffield.ac.uk

2. CLAHRC for South Yorkshire NIHR Collaboration for Leadership in Applied Research and Care for South Yorkshire (CLAHRC) 5 year programme of applied research and implementation of research focusing on self management of long-term conditions Collaborative partnership between universities and healthcare providers over defined geographical area Partnership working to support capacity building for research and implementation £20 million over 5 years – £10m from NIHR with matched funding from partners Barnsley Doncaster Rotherham Sheffield

3. CLAHRC for South Yorkshire Translating Knowledge into Action (TK2A) The aim is to achieve improvements in the quality of patient care, service delivery and commissioning of healthcare services through developing step change in the implementation of research and innovation into healthcare practice.

4. CLAHRC for South Yorkshire Clinically focused KT projects Management of patients with dysphagia Oral nutrition support for patients at risk of malnutrition Reducing the risk of hospital acquired VTE

5. CLAHRC for South Yorkshire KT approach: K2A Projects address healthcare partners priorities Shaped by K2A cycle (Graham et al 2006) Involves working at different levels within and across organisations Shared ownership and responsibility for success Participatory ways of working to achieve change.

6. CLAHRC for South Yorkshire KT process Approaches to achieving behavioural change include internal and external best practice champions, microsystems coaches and education facilitators. A broad range of KT strategies are used. Achieving behavioural change at micro level has required investment at meso and macro levels. Strategies for change include boundary spanning and knowledge brokering at multiple levels, connecting with a broad range of stakeholders, collaboration and co- production throughout the journey and negotiating multiple agendas in prioritising actions.

7. CLAHRC for South Yorkshire Sustaining behavioural change Sustaining behavioural change and promoting spread within and across organisations has proved challenging because of contextual issues operating at macro and meso levels. Negotiating the ‘swampy lowlands of practice’ while drawing upon the ‘high ground of theory’ (Schon 1983) has led to tailored approaches to embedding change leading to valuable lessons to share.

8. CLAHRC for South Yorkshire Challenges of change Implementation in the real world is complex and messy. We need to be able to deal with unpredictability, be able to adapt and cope with complexity.

9. CLAHRC for South Yorkshire Challenges of Change Learn about the challenges of sustainability and spread of behavioural change by playing our crocodiles and kangaroos game. Discover the barriers and enablers to achieving change and see if you can be successful in the end.

10. CLAHRC for South Yorkshire Crocodiles and Kangaroos Place the koala bear on the square marked start. Throw the dice and move the koala the corresponding number of squares along the board. If you land at the foot of a ladder with a kangaroo, move the koala to the top of the ladder and select a card with a picture of a kangaroo – on the back of the card you will find details of an enabler we encountered to sustainability and spread. If you land on the head of a crocodile, move the koala to the bottom of the crocodile and select a card with a picture of a crocodile – on the back of the card you will find details of a barrier we encountered to sustainability and spread. Continue to throw the dice. On reaching the final square, celebrate your success! Add your own experiences of the enablers and barriers to sustainability and spread by completing a blank card. Challenges of Change: rules of the game

11. CLAHRC for South Yorkshire Innovation in the sustainability and spread of behavioural change: lessons from the NIHR CLAHRC South Yorkshire, UK www.clahrc-sy.nihr.ac.uk