Adapting improvements to context: when, why and how?

There is evidence that practitioners applying quality improvements often adapt the improvement method or the change they are implementing, either unknowingly, or intentionally to fit their service or situation. This has been observed especially in programs seeking to spread or 'scale up' an improvement change to other services. Sometimes their adaptations result in improved outcomes, sometimes they do not, and sometimes they do not have data make this assessment or to describe the adaptation.