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Spread

Spread aims to share and extend successful changes to new departments, areas, and teams. This process takes place after testing and refining intervention through multiple PDSA cycles. While adaptations may be needed, learning from earlier tests provides a strong foundation and reduces the need to start from scratch.

Key Steps

  • Identify what worked and why by reviewing data and past PDSA cycles. This will help your team define the core components of your intervention that led to improvement.
  • Evaluate the readiness and context for new areas that you would like to spread. Each context is unique and requires special consideration.
  • Tailor the intervention as needed, involve local stakeholders early, and build buy-in by sharing results from the original project. A change packet is a great tool to share.
  • Support implementation and keep learning as you go. Provide tools, coaching, and ongoing feedback opportunities to new teams as they test and refine the intervention.

Resources to Get Started

Read
  • A Framework for Spread: From Local Improvements to System-Wide Change: This white paper provides a snapshot of IHI’s latest thinking and work on spread. It includes examples of how the VHA applied the framework to spread improvements in access to care for more than 1,800 outpatient clinics
  • Spread & Sustainability-How to Guide: This document was created as a part of IHI’s Protecting 5 Million Lives From Harm, Getting Started Kit. This guide provides some practical tips for generating spread and sustainment including best practices and examples of success
Use
  • Enhancing Project Spread and Sustainability: A classic resource which provides helpful tips, practical advice and a framework for successful spread and sustainment of performance improvement
  • Change Packet Template. A toolkit of information that can inform the planning, implementation and evaluation of a healthcare improvement initiative that aims to create lasting benefits to patient, family and/or caregiver experience, health and/or work life of providers developed by the Canadian Foundation for Healthcare Improvement.

Related QI Concepts

  • Plan-Do-Study-Act (PDSAs) – It is encouraged to review PDSA cycles from the original project; PDSAs are also helpful because your team is able to test out potential adaptation for the new intervention that you are trying to spread.
  • Project Charter – It is helpful to review an intervention’s project charter to learn more before attending to spread to other contexts.
  • Stakeholder Analysis & Engagement – People drive the work of any project so it is important to consider how you will engage key stakeholders throughout your project and beyond.
  • Sustainment Planning – Sustainment and spread often go together because interventions spread once a project is successful and sustained over time.