1. Managing Spread September 18, 2000

2. Target Population for Spread Population of Focus for your Aim Spread -Other clinicians -Other clinics -Other organizations -Other diseases

3. Theoretical Diffusion Curve

4. Year Number of Farmers 100 150 200 250 300 0 50 19271928 1929193019311932 1933 1934 1935 193619371938193919401941 Source: Based on Ryan and Gross (1943). Example of Rate of Spread # Adopters of Hybrid Seed Corn in Two Iowa Communities Cumulative Number of Adopters

5. Readiness to Begin Spread n There is an intention to spread the work of the Collaborative team in the organization n A System of Care (e.g. diabetes) is a key initiative for the organization in 2000/2001 n A Senior Leader is responsible and accountable for coordination and spread of the chronic care system. n The Collaborative team is relatively self sufficient (has been and will continue to be successful!)

6. What You Can Do to Help with Spread n Help to make the case for change n Make it easier for others to make the changes n Pick the right messengers

7. Help to Make the Case for Change n Two or three good run charts n Promote your work – “Make the message memorable!”

8. Make It Easy for Others to Do the Work n Develop the details regarding the changes n Identify and document the ways to reduce the transition issues

9. n Guidance on timing and scheduling n Order that the patient sees the providers n Movement of patient and/or providers (when and where) n Pre-visit tasks n Documentation, data collection, and follow-up Details Regarding the Change of Patient Seeing Multiple Providers

10. Examples of Transition Issues n Time away from caring for patients n Training n Reduced productivity because of the learning curve n Making changes to the budget n Change of work tasks and flow n Development of a database

11. Develop the Messengers n Focus on peer-to-peer communication n Identify and choose connectors, mavens, salespeople n Educate the messenger to deliver the message

12. Bibliography n Cool et al. Diffusion of Information Within Organizations: Electronic Switching in the Bell System, 1971 –1982, Organization Science, Vol.8, No. 5, September - October 1997. n Gladwell, M. The Tipping Point. Boston: Little, Brown and Company, 2000. n Rodgers E. Diffusion of Innovations. New York: The Free Press, 1995.