Spreading Changes: Leadership

Executive leaders in an organization play an important role in spread initiatives by supporting and facilitating the efforts. Everett Rogers refers to this as "agenda-setting" in his book, Diffusion of Innovations. Effective leaders perceive a need for innovation in a specific area, prioritize it as one of the organization’s few strategic initiatives, communicate that need for change, and align the goals and incentives within the organization to support it.


Changes for Improvement


Designate an Executive Sponsor for Spread

The executive sponsor is responsible for providing overall guidance to the spread team, identifying and addressing system issues that can either facilitate or impede the spread process, keeping the executive leadership group apprised of the progress of the spread initiative, and serving as an advocate for the improvements at all levels of the organization.

It may be helpful for the executive sponsor to be responsible for the areas within the organization where the changes will be made as part of the spread effort (e.g., outpatient services, medical-surgical units). If the topic to be spread is a clinical one, a senior physician or nurse senior leader should be designated as the executive sponsor or should work closely with the executive sponsor. This aligns the clinical and operational structure and provides unified leadership for spread.


Assign a Day-to-Day Manager for Spread

The responsibilities of the day-to-day manager for spread or “spread agent,” include the following:

  • Lead the spread team
  • Work closely with the senior leader responsible for spread to develop the spread plan, identify system issues needing attention, and provide feedback on progress
  • Package the improvements for easy adoption by the target population
  • Develop and coordinate communication strategies to build awareness of the improvement and attract interested adopters
  • Identify methods to provide technical support to adopters, linking those individuals with experience with those that need information or support
  • Identify and develop messengers who can promote the improvements in the target population and attract adopters to the improvements
  • Identify and build communities related to the improvements within the target population
  • Identify system barriers to adoption and bring these to the attention of senior leaders
  • Monitor and track the progress of the spread effort and provide feedback to the target population
  • Capture and transfer knowledge about the spread process from the target population to the spread team and senior leadership


Utilize other members of the spread team as well as organizational resources to assist the spread agent with the activities needed to support spread. For example, enlist an organization’s marketing and communication department to help develop communication strategies and prepare communication materials. Call upon information systems staff to develop electronic methods for collecting data needed to monitor the extent and rate of spread.


Ensure the Topic to Be Spread is a Key Strategic Initiative of the Organization

Executive leadership must first determine if a particular set of improvements is of strategic importance to the organization before spreading them. If so, the improvements should be included in the organization’s strategic plan and then communicated throughout the entire organization. For spread of improvements to be successful, leadership needs to provide a clear and unambiguous message that the status quo is unacceptable and that the improvements to be spread are central to the future success of the organization.

Communicate the strategic importance of the improvements in various ways to the organization, particularly to those in the target population. Some methods include:

  • Prominent placement in the organization’s strategic plan
  • System-wide messages, publications, and website content
  • Leadership meetings and organization events
  • Endorsement from the board or governing body of the organization


Align the Goals and Incentives of the Organization with the Topic to Be Spread

Goals and incentives are communicated through policies that are translated into action by senior and middle-level management. For example, adoption of the selected improvements can be linked to department and individual yearly performance objectives. In addition, leadership should be aware of, and eliminate, any existing incentives that would create barriers to the adoption of the changes such as compensation packages, job categories and descriptions, or promotional practices.

The alignment or misalignment of goals and incentives often become evident through the work of the initial improvement team. Study the experience of the initial team and consider organization-wide implications for policies and procedures in order to facilitate the spread of the improvements.

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