How to Improve: Model for Improvement: Spreading Changes

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Model for Improvement: Spreading Changes

Spread is the process of taking a change that has been successful in one context and using it in another. Successful spread efforts require leadership, better ideas, a set-up strategy, communication, measurement, and feedback.

From the perspective of those adopting the changes, they must go through the same process of testing, adapting, and implementing the change ideas. However, a well-designed, resourced, and led organizational spread strategy can accelerate the journey to results.

Spread efforts will benefit from the use of the PDSA cycle. Systems adopting the change need to plan how best to adapt the change to their unit and to determine if the change resulted in the predicted improvement.


  • Implementing a change: A new medication reconciliation form is made standard practice in one hospital. The form is embedded in the electronic health record (EHR) and all new staff are trained on it.
  • Spreading a change: Another hospital in the health system has decided to use the same form. They consult the project sponsor and team lead and invite them to consult with their team to find out what they learned during their testing and implementation phases in order to accelerate the work of testing and implementing the form in their facility.