Social System for Spreading Changes

​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). Spread is successful when a new idea is adopted by the members of the social system in the target population. However, since individuals in a social system do not adopt changes at the same time, moving new ideas from the successful site to the target population is not always a simple process.


Everett Rogers places adopters into categories classified from "innovators" to "laggards" based on this temporal phenomenon and notes that the category may vary based on the change being adopted. The adoption of change in a social system, therefore, will usually start slowly, gain momentum, and then accelerate as more and more persons adopt the changes.

An individual’s willingness to adopt new ideas can also be slowed (or accelerated) by the environment in which he or she works (Brown). Spread agents should take an active role in "listening" to the target population to understand barriers to adoption and develop ways to overcome them (Dixon). This might include bringing to the attention of management the need for new equipment or arranging peer-to-peer discussions about specific issues.
Changes for Improvement


Develop and Use Key Messengers

Key messengers are those individuals who advocate for the improvements to be spread. Key messengers play an integral part in the communication campaign by building awareness and providing information about the improvements to others in the target population who are ready to begin adoption. Early adopters from the successful sites or opinion leaders are often the best key messengers. Early adopters can speak from their own experience, while opinion leaders have the influence and respect within the target population to serve as powerful attractors to others. (Lomas (1991) and Soumerai (1998))



  • Be careful not to disrupt the informal leadership position that some opinion leaders may hold in the social system by asking them to take on a more formal key messenger role. Sometimes it is more effective for opinion leaders to utilize their natural channels of friendship or professional relationships to advocate for the improvements.



Build Communities to Spread Improvements

The relationships and social connections that exist among individuals in the target population can affect the rate of adoption of new ideas. Everett Rogers describes the role that "early adopters" play in bridging the gap between the "innovators" (the source of the ideas) and the "early majority" (those who watch and listen to the early adopters). The early majority is more likely to consider adopting a new idea if "someone like them" has tried it.


Brown (2000), Dixon (2002), and Wenger (1998) suggest bringing together groups of individuals with similar jobs and interests to form communities of practice. Communities of practice provide the help and support that adopters often need in applying the improvements to their local areas (Bandura). Through personal interaction, communities of practice also serve as mechanisms for transferring the detailed technical knowledge (i.e., concepts, specific changes, and tips) about the improvements that is often difficult to convey through printed material or formal training sessions.



  • Investigate whether communities of practice such as professional groups or even social networks already exist. If not, build communities of practice by providing opportunities for those with similar job positions or responsibilities to meet and discuss their issues, concerns, learning, and challenges with adapting the improvements to their own settings.



Identify People and Mechanisms to Provide Technical Support

The social system is the source of the people and mechanisms that provide technical support to those in the target population who are ready to adopt the improvements. Basic technical information about how to make the improvements can be packaged in various forms such as manuals, websites, audiovisual presentations, etc. These communication tools can serve as excellent resources for adopters by providing initial guidance on how to get started, detailed instructions about implementing specific improvements, and other pertinent information that is relatively straightforward and easy to explain.


However, adopters often need a deeper level of support and information that is best communicated through interaction with colleagues. Avorn (1983) discusses the benefits of person-to-person contact in educational outreach. Szulanski (2002) suggests visits to a high-performing site to aid in replication of "better ideas" or best practices. Those individuals from the successful sites with personal experience implementing the improvements are often the most effective providers of technical information.



  • Leverage the time and resources of those individuals with experience from the successful sites by setting up scheduled conference calls or regular "office hours" when they are available for consultation and advice. Once a personal relationship is established between those with experience and the adopters, online communication systems (i.e., listservs or discussion groups) may also be effective tools for providing ongoing information and support.



Remove Obstacles to Spreading Improvements

Transition issues include infrastructure or system-level obstacles that can slow the rate of spread. It is important to identify and remove these obstacles that slow the spread of improvements from a successful site to the target population. Examples of such obstacles include features of the information system, staffing policies or procedures, and compensation or reimbursement systems. The spread agent is responsible for working with the successful site to identify the issues and bring them to the attention of the executive leaders for resolution.



  • Once the spread effort is under way, continue to monitor the target population for additional issues that may impede the process of adoption.


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