ISSaQ is a questionnaire that enables scaling teams in health and social services to assess the scalability of innovations. It is evidence-based and helps identify areas for improvement in innovations and scaling projects to ensure their success.
You can use ISSaQ at various stages of scaling up an innovation:
- Before implementing the pilot innovation
- Before scaling up the innovation
- During or after scaling up the innovation
A tool that fosters patient and citizen engagement
ISSaQ was developed using an integrated knowledge translation approach and incorporated input from patient and citizen partners at every stage of its development. As a result, the tool encourages patient and citizen engagement as it is scaled up. However, this engagement will require innovation teams to make an effort to conduct discussions in accessible language and to clearly identify the skills of patients and citizens who can contribute to assessing the potential for scaling up their innovation.
ISSaQ Definition
Innovation Scalability Self-Administered Questionnaire
Definitions of scaling up innovations and assessing the potential for scaling up
Scaling Up Innovations in Health and Social Services
A set of deliberate efforts to increase the impact of an innovation that has proven effective in pilot or experimental settings, through the dissemination, replication, or adaptation of innovations in health and social services.
Assessment of the scalability potential of a health and social services innovation
This aims to ensure that the innovation has the potential to be disseminated, replicated, or adapted to new contexts, while maintaining its effectiveness and thereby increasing its impact.
ISSaQ tool glossary
Refers to how well it achieves its intended outcomes or goals in addressing a specific problem or need. It typically measures the impact, efficiency, and overall success of the innovation in practical applications.
Groups of people distinguished by their ethnic background, culture, or perceived race, who experience social, economic, or political marginalization due to societal structures and biases. The term “racialized” highlights the social process of assigning racial identities, often leading to discrimination or unequal treatment.
Data obtained using rigorous scientific methods such as experimental or observational studies. Evidence-based data can include quantitative data (numbers, statistics) and/or qualitative data (observations, testimonials).
The first implementation of the innovation in a pilot or experimental context.
Team responsible for scaling the innovation.
Interventions that are new, or perceived as new by their beneficiaries, or interventions adapted to new contexts.
The context in which an innovation was implemented for the first time.
Infrastructure such as equipment, measures and qualified human resources necessary for guiding and monitoring scaling.
Partnerships necessary for scaling the innovation, e.g. partners from various sectors such as financial organizations, suppliers, community associations and governments.
The context/s into which an innovation will be scaled.
The institutional arrangements needed to scale an innovation, such as authorizations from management, a governance committee and political and community support.
Active participation of patients and citizens in the scaling of innovations in health and social services through collaboration and the co-production of ideas, plans, documents, tools, solutions and evaluations throughout all phases of the process.
Language that is understandable and usable by as many people as possible, including those with different abilities or needs.
Barriers at the level of political decision-making and public policy implementation that may block scaling. These may be conflicts of interest between different groups, bureaucracy and institutional resistance to change, and legal or regulatory constraints.
Qualified personnel who are either already able to contribute to scaling the innovation, or who are willing and able to be trained to do so.
Relevant data are consistent, appropriate and respond to a specific question or scaling goal. High-quality data are reliable in terms of the data collection methodology, the sampling, and the validity of the measures.
Potential of an innovation to be expanded, replicated and adapted to new contexts while maintaining its effectiveness and thus increasing its impact.
Components that have been identified in the scientific literature as essential to the success of scaling innovations in health and social services.
Effort to increase the impact of a health innovation proven effective in local or experimental contexts through expanding, replicating and adapting it.
The stage before scaling, including establishing the team, partnerships, infrastructure and everything else necessary for proceeding with scaling. Some authors recommend developing a scaling plan at this stage.
User representatives, beneficiaries, organizations and persons working in health research or health and social services, funding bodies and decision makers, all of whose perspectives are necessary for scaling the innovation.
Elements that take into account inherent social and power inequalities in society that result in, for example, differences in access to health care for women, men, cisgender, transgender and non-binary persons.
The population and/or services that will benefit from scaling the innovation.
Persons, communities and groups frequently faced with discrimination and prejudice because of their characteristics or position in the social structure. These are people of African descent, Indigenous people, Roma, Sinti and Travellers, people belonging to national, ethnic, religious or linguistic minorities, migrants, refugees, asylum seekers, internally displaced people, people living in extreme poverty, women, LGBTQ2S+ people, people with disabilities, and older people.
Healthcare partner (patient, service user, family member, citizen)
Researcher or research professional
Healthcare professional
Social services professional
Decision-maker or manager
Professor
Student
Continuous Improvement Officer and Regional Continuous Improvement Officer (AACQ – ARACQ)
Family Medicine Clinic or Family Medicine Group
Clinical Coordinator
Others
- Users: Articulate their needs and ensure the innovation is relevant
- End users: Verify acceptability, equity, and cultural appropriateness
- Health organizations: Plan, document, and structure scaling up
- Funding agencies: Assess quality, feasibility, and potential impact
- Decision-makers: Ensure policy, legal, and strategic alignment
The questionnaire is self-administered and consists of 37 items organized into 12 components, which are:
C1. Social or health issue addressed by the scaling-up
C2. Development of the scaling-up
C3. Characteristics of the scaled-up innovation
C4. Policy context of the scaling-up
C5. Efficiency of the scaled-up innovation
C6. Costs of the scaling-up
C7. Adaptability of the scaled-up innovation
C8. Coverage of the scaling-up
C9. Acceptability of the scaled-up innovation
C10. Scaling-up environment
C11. Infrastructure required for scaling up
C12. Sustainability of scaling up
In the case of the MOBILIZE project, an innovation aimed at reducing the error rate in the receipt of test results is to be scaled up in a new FMG-U (University Family Medicine Group)
Using the guide
ISSaQ 4.0 is used to assess the innovation’s transferability, identify needs, structure the scaling-up process, and support decision-making regarding scaling up.
Impact
- Informed decision
- Better understanding of the innovation
- Strengthened mobilization
- Action plan tailored to the new setting
- Roberta de C. Corôa: Postdoctoral Researcher
- Ali Ben Charif: Researcher
- Karine V. Plourde: Research Professional
- Amédé Gogovor: Assistant Professor
- France Légaré: Full Professor
This tool is the result of the project “Développement d’un outil d’évaluation du potentiel de mise à l’échelle des innovations en soins de santé communautaires de première ligne (tool validated by a Delphi study),” funded by Unité de Soutien SSA Québec as part of the 2021–2022 transition projects. The project was conducted in collaboration with the Canada Research Chair in Shared Decision-Making and Knowledge Translation at Université Laval and received support from the Centre for Sustainable Health Research – VITAM.
Corôa RC, Ben Charif A, Plourde KV, Gogovor A, Légaré F. Innovation Scalability Self-Administered Questionnaire – ISSaQ 4.0. Québec: Unité de Soutien SSA Québec; 2025, September p. 1–27.