The optimal combination of characteristics and practices that support spread as suggested by theorists as well as the experience of organizations that have been successful in spreading new ideas together form a Framework for Spread. This framework has been used by organizations to help plan and carry out their spread activities:

• Leadership: Setting the agenda and assigning responsibility for spread
• Set-Up: 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" for the new ideas 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 Model for Improvement* is a simple yet powerful tool for accelerating improvement. Many health care organizations have used the model (shown below) to test changes on a small scale with Plan-Do-Study-Act (PDSA) cycles.**

The size and composition of the team needed to guide the spread of new ideas within an organization may vary depending on the size of the organization as well as the changes that are being spread (e.g., patient safety, improved access in the outpatient setting, care in the intensive care unit). Several areas of expertise and/or responsibility should be considered when forming a spread team. Forming the Team

	Setting Aims Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected.
	Establishing Measures Teams use quantitative measures to determine if a specific change actually leads to an improvement.
	Selecting Changes All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement.
	Testing Changes The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.

Sources:

*Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.

**The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study."