Spread is Not Butter Theresa Fillatre Atlantic Node Leader October / November 2007

Atlantic Node Herding Cats VIDEO

Atlantic Node  Dissemination is the science of taking a local improvement intervention, idea or process & actively spreading it across the system (spread )  Possible definitions of a system include:  A single healthcare setting, a group of hospitals, a health region, or an entire country’s health system The Basics: Dissemination Science

Atlantic Node  An Executive Sponsor to own and lead the spread plan  A day to day spread manager to oversee the implementation strategy  A strategically directed & resourced spread plan to ensure standardization, action, & studying continues through the implementation phase  Organizations are encouraged to begin to map spread plan ideas as each improvement charter is initially designed Executive Ownership of Spread

Atlantic Node Knowing When to Spread  Once PDSA cycles have been tested thoroughly in one or more initial pilot sites.  When innovations / improvements lead to measured results that are clearly better than what the baseline performance was.  Spreading the “wrong change ideas” without adequate testing and refinement in PDSA cycles could worsen baseline performance.

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Critical Communication  Develop an overarching spread plan  Avoid top down and look at horizontal communication vehicles  Engage spread agents from front-line teams, managers and support staff involved in pilots  Key messages must convey the rationale for spread and pilot results  Avoid underestimations of the real time spread requires & factor in 20% for the anticipated interruptions

Atlantic Node Knowing Your Spread Plan is Working  Continue to study and refine through implementation  Profile the baseline and performance measures through implementation  Respond to contextual differences  Seek & respond to feedback from those involved  Implement the standardized protocols in the new areas

Atlantic Node Books for the Knowledge Thirsty  Spreading Good Ideas for Better Healthcare, Paul Plesek  Diffusion of Innovation, Everett Rogers  The Tipping Point, Malcolm Gladwell  Undressing the Elephant: Why Good Practice Doesn’t Spread in Healthcare, Sarah Fraser

Atlantic Node Your Spread Tools  IHI White Paper on Spread (QIM)  IHI Spread Planner for Leaders( QIM / Pkgs)  SHN! Spread Checklist (Pkgs)  SHN! QIM Community of Practice (Learning & Sharing Together)

Atlantic Node Conclusions  Systems make spread possible  People Make Spread Happen  Leadership Makes The Spread Plan Work  Ongoing Standardization, Planned Action and Ongoing Studying Reduces the Risk of Needing to “Herd Cats”

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