Measurement and Feedback for Spreading Changes

A measurement system for spread includes the main outcome measures of the process or system of interest (e.g., adverse drug events) and the rate of spread of the specific improvements (e.g., number of care units using unit briefings to identify safety problems). In addition to the measurement system, a feedback system is needed to provide information on progress in reaching the organization’s spread goals to the executive leadership, the spread agent and the spread team, and the adopters in the target population.

There are important considerations in expanding a data collection approach from a single pilot site to the system level. As with all measurement for improvement, to reduce the burden of data collection, sampling should be used in assessing improvement in spread projects. Other things to consider in collecting data at the system level include availability of data in automated systems, building data collection into the current patient care process, and refining the sampling plan.
Changes for Improvement
Track and Monitor Progress

The organization should track and monitor its progress in reaching its spread goals (i.e., outcome measures) and the rate of adoption of the improvements in the target population. Tracking and monitoring the progress of spread involves ongoing data collection, producing regular reports, and providing information to both executive leaders and the adopters in the target population. The outcome measures are often available through automated systems. Data on the rate of spread, however, is often difficult to collect as part of an already existing information system and must be collected and reported by the sites in the target population.


The spread agent compiles both the outcome measures and the data on the rate of spread at least monthly and shares the reports with executive leadership and the adopters. Measurement for spread, as is the case with measurement for improvement in local areas, is used to guide the process rather than for judgment. The spread agent and the executive leaders use the spread measures as a diagnostic tool to identify opportunities to accelerate the adoption of the improvements in the target population.



  • Build mechanisms for two-way communication between leaders and the adopters: leaders seek information, hear from the adopters, and provide support and assistance to the adopters to accelerate the rate of spread and achieve outcomes.



Develop an Outcome Measure and a Measure for the Rate of Spread

Measures used to guide the spread process include one or more outcome measures and a measure of the rate of spread of specific improvements. Outcome measures for spread assess whether the improvements being spread are having a positive impact on the performance of the system. The outcome measures used to guide local improvement are often converted to system-level measures during the spread effort. Measures for the rate of spread assess the extent to which key ideas or process changes are being spread from the local level to sites in the target population.



  • Compare outcome measures for the sites in the target population with their progress in adopting the recommended improvements (rate of spread) in order to identify gaps in technical knowledge or support that the adopters may need in order to fully adopt the improvements.


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