The core of this glossary was developed by Horizons and AAC based on key reports and references along with information from NHS organisations. We are aware that in practice there are multiple and variable definitions in use which leads to a confusing situation especially as terms are often used interchangeably.

Main terms

Adoption – to put something new into practice that has been used elsewhere

Adopter – an individual, team or organisation that implements a change in a different location to the one in which it was originally developed

Adaptation – a modification made by an adopter to the innovation or improvement, compared to the original version, as they put it into practice in their location [site or setting]

Implementation – process of adoption which involves often adaptation

Spread – replicating an innovation across multiple locations. In practice the terms spread and scaling blur together, and are often used interchangeably, the term spread is used in this publication to cover spread and scaling [which is sustained].

Scaling – a subset of spread that requires (infra)structural changes particularly across an organisation, locality or health system to support full scale implementation

Sustainability – when the new way of working and improved outcomes become the norm, evolving as required, definitely not going back to the old way

Diffusion – when something new is shared with others in a natural and non-organised way

Dissemination – organised and planned efforts and communications to persuade target groups to spread and adopt something new

Innovation – an idea, practice or object that is new to that location [site or setting].

Improvement – iterative and ongoing change [within an existing service model] to make something better

Additional terms

System – a system is an organised collection of parts (or subsystems) that, when working well, are highly interdependent and integrated to accomplish an overall goal

System convening – is an enabling leadership behaviour needed to create the conditions, connecting across boundaries, to enable complex change

Learning system – for an organisation described as organisational structures, processes, and culture that promote internal learning so the ability to learn is embedded at every level, and reinforced through the culture and behaviour of staff, including what leaders say and do.

Complex adaptive system – a system’s performance and behaviour changes over time and cannot be completely understood by simply knowing about the individual components

Complexity – when you can’t predict with certainty the result of actions, there is no cause and effect, the same actions may produce a different effect each time.

Adaptive space – temporary safe [virtual] space at interface of normal business and the innovation where through developing relationships, addressing tensions, shared learning and working with emergence spread and adoption can be enabled.

Polarity – two opposite or contradictory tendencies, opinions, or aspects both of which need to be considered

Agency – the ability of an individual or a group to choose to act with purpose

Intrinsic motivation – doing something for the inherent satisfaction that engaging in the activity provides

Extrinsic motivation – doing something because it leads to separate outcome e.g. reward, recognition

Power – new power is based on relationships and held by many, old power is based on structures and processes and is held by a few

Network – a group of people who collaborate on a shared purpose. The purpose can be to learn together, to deliver something together, to campaign together.

Stakeholder – person or organisation that has an interest in and can either affect or be affected by the change.

This guidance is primarily offered to support system leaders. Please send all feedback to