What it really takes to scale pilots in large systems

When there is an increasing focus on introducing new innovations, the question that organisations need to ask is whether the innovations can be sustained at scale after the pilot phase.

In large systems, early success, through pilots or initial rollouts, is often seen as a sign that a programme is working.

A new initiative is introduced, a small group is trained, and early results look promising. At this stage, it is easy to feel that the programme is “working”.

Proof-of-concepts (POCs) may help test what works but without early consideration for scale, what works in a controlled setting may not hold in practice.

In practice, the pilot is the easiest part.

The real challenge is making a pilot work at scale, across large groups of people, through different workflows, and everyday operational pressures.

This is where many initiatives slow down or lose impact.

Making programmes work in practice

This pattern is not limited to a single programme.

Across different initiatives, from system implementation to workforce programmes, similar challenges tend to emerge.

In one workforce programme I worked on, the main challenge was not introducing the new system itself but ensuring that backend processes were able to keep up.

What this means in practice is that results are properly recorded, especially when staff moved across institutions.

Although the system functioned as intended, there were still gaps in how records were updated across institutions.

This meant that results are not always available when needed and this created a risk of processes being repeated unnecessarily.

Addressing these required adjustments to how data was tracked and maintained, so that records remained usable beyond a single institution or point in time.

Over time, this supports a more prepared workforce and enables better planning of resources, especially during periods of increased demand such as a pandemic.

One thing to try

When scaling a programme, go beyond rollout plans and ask a simple question:
“Will this still work when people are busy, workflows differ, and support is limited?”

The answer often reveals what needs to be addressed before scaling further.

When programmes scale, gaps that were not visible earlier start to appear.

In practice, this often shows up when work moves beyond a single team or setting. Processes that work well within one context may not hold when applied across different teams or institutions.

As more people become involved, ownership became less clear.

At the same time, completing a process does not always mean the outcome can be reliably used afterwards, especially when data does not move as expected across systems.

Without clear visibility, these gaps are not always obvious until they begin to affect day-to-day operations.

These are not issues of intent, but a reflection of how large systems operate in practice.

Pilot addresses the unknown, scaling introduces complexities

Pilots are usually conducted in controlled conditions with select participants and with teams that are closely supported with issues being quickly addressed.

At scale, variability becomes the norm:

• Teams operate with different routines and constraints
• Documentation practices vary
• Operational priorities compete for attention

What works for a small group does not automatically carry across a larger system.

The gap is often not in the design of the programme, but in how it fits into everyday work.

New technologies do not guarantee adoption

Workflows are mapped, systems are configured, and training is conducted. From a delivery perspective, everything appears to be in place.

But adoption varies.

Some teams adapt quickly. Others continue with familiar ways of working, even when new systems are available.

It is often assumed that once a system is introduced, change will follow. In reality, adoption is not a guaranteed outcome but shaped by how people work in practice.

If the new workflow does not align with daily routines, workarounds will appear. Over time, these workarounds can limit the intended value of the system.

Moving beyond the pilot mindset

Large systems have no shortage of ideas or pilots.

What is often underestimated is the effort required to make these initiatives work consistently, at scale, under everyday conditions.

Digital tools and new programmes play an important role. But their impact depends on how well they are used in practice, across different teams and situations.

As organisations continue to invest in new programmes and systems, the ability to make them work in everyday conditions will become increasingly important, not just to deliver results, but to sustain them over time.

Even successful scaling is not permanent. Over time, what works today becomes tomorrow’s legacy, requiring review and adjustment as systems and technologies evolve.

------------------------------------------------------------------------

The author is a Senior Assistant Manager at the Singapore General Hospital (SGH), and she leads programme delivery and system implementation initiatives across multiple infection prevention domains in a large acute hospital, working at the intersection of operations, systems, and stakeholders.