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Background  Increasingly, theorists and academic researchers develop, implement and test frameworks and strategies for improving the safety, effectiveness and efficiency of health care—at scale. The purpose of this research was to surface the views of health system managers and frontline personnel charged with implementing these improvement processes, to better understand key to success from personal experience.    Results  A total of 17 out of 21 individuals invited to participate took part. Respondents, who were experienced senior managers and executives from various health agencies, provided comments via semi-structured discussions that lasted approximately 1 h. The discussions broadly focussed on what enables and inhibits the wider application of innovations to improve health service delivery. Respondents identified a number of broad factors that underpinned the successful and sustainable implementation of innovative initiatives: (1) a sound business case or ‘case for change’; (2) good preparation for the change process and thought given to how the initiative could be adapted to different contexts; (3) good engagement of clinicians, administrators and others; and (4) good support provided through the implementation phase, including having the right people, structures and strategies in place to coordinate implementation across the system.    Conclusions  Measured responses that acknowledge both the tangible and less tangible aspects of a change process are required for the planning and implementation of large scale, successful and sustainable change initiatives across complex health systems.

Towards the implementation of large scale innovations in complex health care systems: views of managers and frontline personnel