McCannon CJ, Perla RJ. Learning networks for sustainable, large-scale improvement. Joint Commission Journal on Quality and Patient Safety. 2009 May;35(5):286-291.

This article suggests that learning networks are instrumental mechanisms in sustainable, large-scale improvement. These networks establish communities of directed learning focused on changing behavior and practice on a large scale, offer structured opportunities for exchange of information, and provide practical insight on adapting known protocols to particular settings. Examples from national hospital patient safety initiatives in the UK, Scandinavia, Japan, and the US, including IHI’s 5 Million Lives Campaign, are shared.

Balas EA, Boren SA. Managing clinical knowledge for health care improvement. In: Bemmel J, McCray AT, editors. Yearbook of Medical Informatics 2000: Patient-Centered Systems. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000:65-70.

The authors assess the growth in clinical research studies coupled with a slow rate of adoption, often taking an average of 17 years for new evidence-based findings to reach clinical practice. Some issues discussed include the need for a more efficient information infrastructure to better connect front-line professionals with the research community, difficulties in translating research into practice, and an inadequate system to help health care clinicians evaluate the strength of new study findings.

Bisognano M, Conway J, with Schummers D
Chicago, Illinois: Health Administration Press with the Institute for Healthcare Improvement; 2008

This is the fourth book in a series for health care executives designed to share innovations in patient care that are reliable, ready for implementation, and have been used successfully. Each chapter provides a description of the idea, an example of it in practice, and the results that have been achieved, where available. Topics include: harnessing and leveraging the power of middle managers; assigning personal guides to help patients and families navigate the treatment process; using simulations to train staff and promote behavioral and cultural change; engaging board leaders in patient safety and quality initiatives; others.

ExpandNet and World Health Organization. Practical Guidance for Scaling Up Health Service Innovations. Geneva, Switzerland: World Health Organization; April 2007.

Based on an analysis of scaling-up literature and the experience of scale-up efforts in several countries, the guide includes a framework for scaling up; attributes of innovations, organizations, environments, and teams that support successful scale up; and strategies for various scale-up and dissemination approaches.

McCannon CJ, Berwick DM, Massoud MR. The science of large-scale change in global health. Journal of the American Medical Association. 2007 Oct;298(16):1937-1939.

Innovation in health care and, in particular, the rapid spread of effective changes such as new medicines and innovations in health care delivery are often slowly and unreliably adopted. Innovations remain hidden in pockets around the globe, flourishing locally in settings where local problem solvers create effective new approaches to problems without reliably reaching those in need elsewhere. This article describes the science behind spreading large-scale changes in a global health care setting.

Schall MW, Nolan KM (eds.)
Oakbrook Terrace, Illinois: Joint Comission Resources and the Institute for Healthcare Improvement; 2007

This new book from Joint Commission Resources and the Institute for Healthcare Improvement shows how to contribute to or lead the spread of good ideas and practices in health care organizations and systems to accelerate improvement. Spreading Improvement Across Your Health Care Organization is the first book on spread in health care. Nolan and Schall describe the Framework for Spread, and chapter-length case studies show how to apply the framework in practice.

Barabasi, AL
New York, New York: Plume Books; 2003

Information, disease, knowledge and just about everything else is disseminated through a complex series of networks made up of interconnected hubs, argues the author. These networks are replicated in every facet of human life. This book guides readers through the mathematical foundation of these networks and shows how they operate on the Power Law, the notion that "a few large events carry most of the action."

Cool K, Dierickx I, Szulanski G. Diffusion of innovations within organizations: Electronic switching in the Bell System, 1971-1982. Organization Science. 1997;8(5):543-559.

The authors explore the applicability of traditional diffusion processes within the context of an organization — in this case, the diffusion of electronic switching technology within the companies of the Bell System before its divestiture. The results suggest that the traditional perspective may not apply exactly within organizations because factors other than those traditionally emphasized seem to play an important role in the diffusion of innovations within organizations.

Wenger E. Communities of practice: The social fabric of a learning organization. Healthcare Forum Journal. 1996;39(4):20-26

The author focuses on learning and discusses where and how it happens in organizations — mainly in communities of practice.

Myers DG
New York, New York: McGraw-Hill College; 1992

The author talks about how people think, influence, and relate, including an appropriate balance of basic research and applied material. This edition includes a greater emphasis on social psychology’s applications to both work and in life, and uses video clips and vignettes to emphasize the relevance of social psychology research. Understanding the basics of social psychology and how it influences behavior may be useful to organizations that want to spread changes.