© 2011 AQuA Patient Safety Champions Spread!

Bernie’s New Restaurant

“ Real improvement comes from changing systems, not changing within systems.” Don Berwick IHI

What happens to change efforts in reality? In order of frequency: 1.The effort effectively “runs out of energy” and simply fades away 2.The change hits a plateau at some level and no longer attracts new supporters 3.The change becomes reasonably well established; several levels across the system have changed to accommodate or support it in a sustainable way. Source: Leading Large Scale Change: a practical guide, NHS Institute

Why….. ‘Not invented here’! Lack of organisational strategy….doesn’t fit. Too complicated. Competing priorities. Lack of communication. No plan to support spread. ‘How to spread good ideas’: Greenhalgh et al 2004

Exercise 1 List one or two difficulties you have experienced in trying to communicate good/safe practice to others when your intention was that they adopt it? List one or two other issues you have experienced when trying to implement safer/better practice?

Spread or Adoption As a leader of improvement you can work to ‘spread’ improvement ideas as much as you want, but your ultimate success is determined by whether or not other ‘adopt’ the ideas.

Late Majority Early Majority Early Adopters Tradition- alists Innovators Adopter Categorisation: Speed of Adoption 2% 13%35% 15%

Readiness to begin spread of changes (or adoption) Intention to spread the work in the organisation The topic is a key initiative for the organisation in the next year There is/are improvement champion(s) A Senior Leader is responsible and accountable for coordination and spread of the work The project/programme is relatively self- sufficient The Improvement Guide: Langley et al, 2 nd Edition

What you can do to help with adoption of change? Help to make the case for change…is it an improvement on what was there before? Make the “new way” easier…it fits within current systems. Simplicity of implementation. Consider spheres of influence Develop your network–agents of change –champions –messengers The Improvement Guide: Langley et al, 2 nd Edition

Spread Questions…. Spread What? Spread to Whom and Where? When to Spread? How? 1……5…..25…..125

The “Tipping Point” “The name given to that one dramatic moment in an epidemic when everything can change all at once.” M. Gladwell “The part of the diffusion curve from about 10 percent to 20 percent adoption is the heart of the diffusion process. After that point, it is often impossible to stop the further diffusion of a new idea, even if one wished to do so.” E. Rogers

“tipping point”

Spread Exercise 2 Choose a topic from one of the safety projects at your table. Describe a specific change (not just a vague concept) that is key to the project. How would you manage/encorage the adoption of this safety improvement within your organisation?

NHS Spread & Adoption Tool The Spread and Adoption Tool is a free, easy to use, web-based application. It is a practical tool that represents what we know about spread and adoption. The tool has three sections: Assess – which provides a self assessment of the readiness and likely success of the spread and adoption of any innovation or improvement. Input your information on three areas of People, Innovation and Context. Browse – which provides guidance, access to additional tools and learning from others to help strengthen areas that need attention. -The tool will consolidate the assessment and all bookmarked resources into an that can be sent to you the user as a record and basis for an action plan. It can also be sent to others for discussion and comparison. d_adoption.html d_adoption.html