Why It Matters
When you're excited about sharing an improvement idea, it's easy to fall prey to common pitfalls. IHI calls them the "Seven Spreadly Sins."
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Accelerating the Spread of Innovations: Avoid the “7 Spreadly Sins”

By Derek Feeley | Monday, June 1, 2015

Derek Feeley is Executive Vice President at IHI. In this blog post, he shares his thoughts on scale and the "7 Spreadly Sins."  He invites you to follow him on Twitter @derekfeeleyIHI


He became a patient about a year ago, after suffering a stroke while driving. He spent the next six months in rehab, recovering from both the accident and the stroke. One night, after he was finally back home, he choked at the dinner table and went into respiratory arrest. In a panic, his wife called 911, but he died before he reached the hospital.

Could his death have been prevented?

We’ll never know for sure, but at the IHI/BMJ International Forum on Quality and Safety in Healthcare this past April in London, I heard about an innovative treatment for dysphagia, a serious swallowing disorder that often results from a stroke. Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust, shared the story of a non-invasive, easy-to-administer, and effective treatment for dysphagia. But after 10+ years, it is only slowly wending its way to patients.

A room full of health system CEOs listened as Sir David asked an important question: How can we accelerate the spread of innovative and potentially life-saving approaches in our own organizations and beyond? Someone interjected the well-known statistic that it takes an average of 17 years to spread a proven intervention in health care – that’s 16.5 years longer than it takes for innovations to spread in the technology world.


We know there can be countless challenges associated with getting new products into the market – proving efficacy, translating technology from the lab to the bedside, funding challenges, etc. In my experience, however, a few key issues determine whether an innovative new product or practice will spread and go to scale. These are issues over which we have far more control. At IHI, we call them the “7 Spreadly Sins.”   

Developed by IHI Vice President Carol Haraden and IHI Senior Fellow Roger Resar, the “7 Spreadly Sins” describe what organizations should not do – the practices that interfere with successful spread and scale. You can look at this infographic to see them all, but here are two common mistakes that are particularly resonant for me:

  • Sin #1: Leave all of the responsibilities for spreading improvement to one person. This is often the person who came up with the idea in the first place. To counter this “sin,” we must understand that you need a team to make improvements at scale. You need infrastructure, intentionality, leadership, and socialization. The person with the creativity to come up with the idea for change often needs people with complementary skills to secure wider adoption of the innovation.
  • Sin #2: Attempt to spread a change without paying attention to the context. Understanding culture and context are a big part of getting to scale. To spread innovations successfully, leaders must understand what Joseph Juran would have called the “cultural pattern,” i.e., the “body of beliefs, habits, and practices that make people and organizations behave in a particular way.”

Let us hear from you if you have experienced any of the 7 Spreadly Sins in your own work – or if there are some additional “spreadly sins” you suggest we confess!

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