Spread” PowerPoint Slide Content and Alternative Text

Slide Number and Title Slide Content Content for Alternative Text (Illustration)
Slide 1
Cover Slide
(CUSP Toolkit logo) The “Spread” module of the Comprehensive Unit-based Safety Program (CUSP) Toolkit. The CUSP toolkit is a modular approach to patient safety, and modules presented in this toolkit are interconnected and are aimed at improving patient safety. 
Slide 2
Learning Objectives
  • Define spread and its role within an organization
  • Examine external and internal factors that affect spread
  • Present the components of a spread plan
  • Discuss myths and barriers to spread
  • Define spread and its role within an organization
  • Examine external and internal factors that affect spread
  • Present the components of a spread plan
  • Discuss myths and barriers to spread
Slide 3
Definition of Spread5
  • “Spreading takes the process from the narrow, segmented population(s) or group(s) and broadens it to include all the population(s) or group(s) that will use the process.”
  • “Formalizing a process provides a reference to others; those new to the organization and those in the organization needing clarity about the specifics of the process.”
A team of providers, the number of which is steadily increasing to include a range of providers, patients, and family members.
Slide 4
Why Spread?
  • Health care culture is local
  • Quality interventions target a process in small pilot projects usually on a local level (Lean Six Sigma, Plan-Do-Study-Act [PDSA])
  • Safety interventions targeted at the unit level (CUSP)
  • Shifting the paradigm—from hierarchical to team culture
Slide 5
Spread Framework6

  • Topic is a key strategic initiative
  • Goals and incentives aligned
  • Executive sponsor assigned
  • Day-to-day managers identified

Measurement and Feedback Better Ideas

  • Develop the case
  • Describe the ideas


  • Target population
  • Adopter audiences
  • Successful sites
  • Key partners
  • Initial spread strategy

Social System

  • Key messengers
  • Communities
  • Technical support
  • Transition issues

Communication (awareness & technical)
Knowledge Management

Adapted from the IHI Framework for Spread. [Massoud MR, Nielsen GA, Nolan K, Schall MW, Sevin C. A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006.] (Available at www.IHI.org)

The Institute for Healthcare Improvement’s Spread Framework involves the following components:
Better ideas,
Social System (including Communication),
Measurement and Feedback, and
Knowledge Management

Leadership plays a key role in the success of the process being spread. Ideas need to be evidence based and easily understood, and they should be beneficial to those who are adopting them.

To generate better ideas, a problem must first be recognized, a case for challenging it must be developed, and ideas need to be shared.

Setup involves knowing the target population—the group that will pilot test the project and develop its protocols before spreading it to populations with similar needs. Key partners need to be identified, the initial spread strategy defined, and successful sites recognized.

The social system influences both the rate and success of spread. Social system refers to the system or environment characterized by the patterns of relationships and behaviors.

Communication should be clear and consistent to ensure a clear understanding of the process being spread and its affect on the population it is spreading to.

Measurement and feedback generate better process ideas and ways to implement change.

Knowledge management and knowledge transfer consist of strategies and practices used to create, capture, organize, and distribute information to all other areas of an organization.

Slide 6
External Factors Affecting Spread7
  • Financial
  • Legal
  • Regulatory
  • Public opinion
  • Moral
  • Organizational priorities
Slide 7
Internal Factors Affecting Spread7
  • Leadership
  • Availability of resources
  • Knowledge and skill set
  • Organizational culture
  • Ongoing improvement efforts
  • Other priorities
A group of providers
Slide 8
Factors that Affect Spread
  Video icon
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Slide 9
What Facilitates Spread Success
  • Evidence-based efforts, tools, and examples
  • Leadership support
  • Easy to adopt
  • Pertinent and relevant issue
  • Able to be piloted or tested on a small scale
  • Observable
A group of providers seated at a conference table viewing a presentation
Slide 10
Spread Sequencing8
  • Developing a change
  • Theory and prediction
  • Testing a change
  • Test under a variety of conditions
  • Implementing a change
  • Make part of routine operations
  • Sustaining and spreading a change to other locations
  • Plan
  • Do
  • Study
  • Act

The Plan-Do-Study-Act cycle. Adapted from the Institute for Health Care Improvement (Available at www.ihi.org)

Improvement requires conducting small tests of change using a method such as a Plan-Do–Study-Act (PDSA) cycle. Once the process has been tested and improved, the team is ready to determine how to sustain the improvements in the tested area and spread it to other areas. This refers to the sequencing of improvement.
Slide 11
Developing a Plan for Spread
  • Inform the team
  • Work with the next unit to spread
  • Account for variability
  • Start with the most adoptable units first
  • Inform the team
  • Work with the next unit to spread
  • Account for variability
  • Start with the most adoptable units first
Slide 12
Work with the Next Unit to Spread
  Video icon
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Slide 13
Account for Variability
  Video icon
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Slide 14
Exercise: Develop a Spread Plan to Decrease CAUTI Rates
  • Goal: decrease CAUTI rates on all floors
  • Care process: Use HICPAC Guidelines for catheter insertion and removal
  • Time: 3 months
  • Criteria to consider: Similar patient populations; similar physicians; staff receptiveness; unit leadership


Exercise icon
Slide 15
Evaluate Spread
  • Quantitative and qualitative approaches are essential for evaluating spread
Providers reviewing a graph
Slide 16
Seven Spreadly Sins
  • Start with large projects
  • Find one person willing to do it all
  • Expect vigilance and hard work to solve a problem
  • If a pilot project works then spread it unchanged
  • Require the person and team who drove the pilot project to be responsible for system-wide spread
  • Look at process and outcome measures quarterly
  • Expect marked improvement in outcomes early on without attention to process reliability
Slide 17
  • Spread can help organizations build on processes that originated at the local level
  • Organizations need to be prepared to address external and internal factors that can affect spread
  • An effective spread plan involves:
    • Strong communication among the team
    • Collaboration with other units
    • Accounting for variability
  • Identification of units able to adopt the process easily
  • Spread plan evaluation is ongoing
Slide 18
  • Voice of the Customer Analysis1
  • Workflow Analysis1
  • Plan-Do-Study-Act (PDSA)2
  • Spread Checklist3
Tools icon
Slide 19
  1. Hagg HW, Workman-German J, Flanagan M, et al. Implementation of systems redesign: Approaches to spread and sustain adoption. In: Henriksen K, Battles JB, Keyes MA, et al., eds. Advances in Patient Safety: New Directions and Alternative Approaches. Vol 2: Culture and Redesign. Rockville, MD: Agency for Healthcare Research and Quality; 2008. www.ncbi.nlm.nih.gov/books/NBK43727. Accessed April 14, 2012.
  2. HRET Spread Assessment Tool. 2011
  3. Institute for Healthcare Improvement. Knowledge Center. How to Improve. www.ihi.org/knowledge/Pages/HowtoImprove/default.aspx. Accessed April 10, 2012.
  4. Massoud MR, Nielsen GA, Nolan K, et al. Framework for Spread: From Local Improvements to System-Wide Change. Cambridge, MA: Institute for Healthcare Improvement; 2006. IHI Innovation Series White Paper. www.IHI.org. Accessed April 10, 2012.
Slide 20
  1. North Carolina Center for Hospital Quality and Patient Safety. North Carolina Prevent Catheter-Associated Urinary Tract Infections Collaborative. North Carolina; 2010.
  2. Massoud MR, Donohue KL, McCannon CJ. Options for Large-Scale Spread of Simple, High-Impact Interventions (Prepared by University Research CO., LLC under Contract No. GHN-01-01-07-00003-00 and GHN-0I-03-07-00003-00). Bethesda, MD: USAID Health Care Improvement Project; September 2010. www.hciproject.org/node/1650. Accessed April 15, 2012.
  3. Edson, B. Navigating the Fleet: Accelerating National Adoption. The Patient Safety Education Program (PSEP) Canada; February 2012.
Slide 21
  1. Cooley L, Kohl R. Scaling Up—From Vision to Large-Scale Change: A Management Framework for Practitioners. Washington, DC: Management Systems International; 2006. www.msiworldwide.com/files/scalingup-framework.pdf. Accessed April 15, 2012.
  2. Lloyd R. Applying the Science of Improvement to Daily Work. Chicago: HRET; 2012
Page last reviewed April 2013
Page originally created April 2013
Internet Citation: Spread” PowerPoint Slide Content and Alternative Text. Content last reviewed April 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/spread/spreadalttext.html