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Spreading Changes


The framework is not meant to be prescriptive or considered as a specific set of interventions. Instead, it is meant to suggest some general areas, based on theory and experience, to consider as a large spread project is undertaken. Factors such as an organization’s infrastructure, culture, size, and strength of the underlying social system and the operational system being spread will influence how the following components of the framework are applied:

  • Leadership: Setting the agenda and assigning responsibility for spread
  • Set-Up for Spread: Identifying the target population and the initial strategy to reach all sites in the target population with the new ideas
  • Better Ideas: A description of the new ideas and evidence to “make the case” to others
  • Communication: Methods to share awareness and technical information about the new ideas
  • Social System: Understanding the relationships among the people who will be adopting the new ideas
  • Knowledge Management: Observing and using the best methods for spread as they emerge from the practice of the organization
  • Measurement and Feedback: Collecting and using data about process and outcomes to better monitor and make adjustments to the spread progress

 

The framework suggests an ordering of the components of the spread process. While there are no clearly defined stages, it may be useful to think about spread occurring within three overlapping phases:

  1. Planning and set-up
  2. Spread within the target population
  3. Continuous monitoring and feedback on the spread process

 

For more information and general tips on Forming the Team, Setting Aims, Selecting Changes, or Testing Changes, see How to Improve.


Leadership
Executive leaders ensure that the spread aim is aligned with the strategic goals of the organization, assign day-to-day leadership for spread, provide overall guidance to the spread team, and ensure communication and involvement of senior leadership in the progress of the spread effort.

Set-Up for Spread
Set-up describes the activities of senior leaders that provide the foundation for launching and supporting the spread of specific improvements.

Better Ideas
The term "better ideas" refers to the set of changes or improvements that have been shown to be successful (i.e., achieved desired results) in a single site or local area within the organization and are now being spread more broadly.

Communication
A communication strategy for spread includes identifying the purposes and appropriate methods of communication needed to support the adoption of the selected improvements in the target population.

Social System
The social system for spread includes the individuals and groups in the target population (i.e., the locations where the transition from the old system to the new one takes place).

Knowledge Management
Knowledge management is the process of gathering information about the spread process as it unfolds in the organization.

Measurement and Feedback
A measurement and feedback system for spread includes collecting and sharing information on the main outcome measures of the process or system of interest, as well as on the rate of spread of specific improvements.

   


Don't Miss This

See the Improvement Methods section for more information on:


 

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A Framework for Spread: From Local Improvements to System-Wide Change

IHI Innovation Series white paper

 

A Framework for Spread white paper