Example 1: Patient Safety

What we intend to spread:
We will spread a safe, efficient, and effective medication system that includes the following key components:

Aim (target levels of system performance):
We will reduce adverse drug events (ADEs) in our hospital from an average of 30 percent of patients experiencing an ADE to less than 5 percent.

Target population for spread (Small System):
We will spread our new medication system from one medical/surgical unit to all inpatient units in our hospital.

Target population for spread (Large System):
We will spread our new medication system from all inpatient units in one pilot hospital to the other 35 hospitals in our system. In the next 12 months, we will spread to 10 hospitals in the same region as the pilot hospital. In the second and third years of this spread effort, we will bring the remaining 25 hospitals in our system into the initiative.

Example 2: Access in Physician Offices and Clinics

What we intend to spread:
We will spread a timely and efficient office practice system that eliminates unnecessary delays in patients obtaining care. The new system includes the following components: work down the backlog, reduce demand, reduce appointment types, understand supply and demand, plan for contingencies, optimize the care team, manage the constraint, and synchronize patient, provider, and information.

Aim (target levels of system performance):
As a result of our efforts, will be able to promise patients care that is timely and efficient and that meets the following target levels of performance:

Target population for spread (Small System):
Within the next year, we will spread access and patient cycle time improvements from one primary care clinic to our five specialty clinics.

Target population for spread (Large System):
Within the next year, we will spread access and patient cycle time improvements from one primary care clinic to the other five primary care clinics and the three multispecialty clinics in
our region. During the second year of our spread effort, we will spread access and patient cycle time improvements to the 50 primary care, specialty, and multispecialty practices in our other three regions.

Example 3: Chronic Conditions

What we intend to spread:
We will spread a new way of delivering care for our diabetic patients that improves patient quality of life and clinical outcomes. We will use the Chronic Care Model to delay and decrease complications from diabetes, ensure self-management, build decision support systems, redesign our delivery system, and become a center of excellence in our community.

Aim (target levels of system performance):
Our target levels of system performance for diabetic patients include:

Target population for spread (Small System):
Our spread plan has two phases. Within the next 12 months, we will spread a new way of delivering care for our diabetic patients from one clinic to the other five clinics in our community health system. During the second year, we will spread our new care model to encompass all of our patients with chronic diseases, including those with asthma, coronary heart disease (CHD), and depression, as evidenced by appropriate measures of clinical effectiveness for each condition.

Target population for spread (Large System):
Our spread plan has two phases. Within the next 12 months, we will spread a new way of delivering care for our diabetic patients from one clinic to the other five clinics in our community health system. During this same period in our pilot clinic, we will expand our care model to include patients with asthma, coronary heart disease (CHD), and depression, as well as those with diabetes (as evidenced by appropriate measures of clinical effectiveness for each condition). During the second year, we will spread our new care model for all patients with chronic disease to the other 25 clinics in our system.