A Framework for Spread: From Local Improvements to System-Wide Change

A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas. Pockets of excellence exist in our health care systems, but knowledge of these better ideas and practices often remains isolated and unknown to others. Too often these improvements remain unknown and unused by others within and beyond the organization. 

Organizations face several challenges in spreading good ideas, including the characteristics of the innovation itself; the willingness or ability of those making the adoption to try the new ideas; and characteristics of the culture and infrastructure of the organization to support change.

In 1999, the Institute for Healthcare Improvement (IHI) chartered a team to develop a "Framework for Spread." The stated aim of the team was to "…develop, test, and implement a system for accelerating improvement by spreading change ideas within and between organizations." The team conducted a review of organizational and health care literature on the diffusion of innovations, and interviewed organizations both within and outside of health care that had been successful in spreading new ideas and processes.

A Framework for Spread evolved that includes seven components:

• Leadership
• Set-Up
• Better Ideas
• Communication
• Social System
• Measurement and Feedback
• Knowledge Management

Since then, the Framework for Spread and our deeper understanding of its content have continued to evolve. This white paper describes the Framework for Spread, major spread projects that IHI has supported through early 2006, and harvests lessons learned about the most effective practices and strategies for spread. The paper also includes a journal article that describes how the Veterans Health Administration (VHA) used the Framework for Spread to spread improvements in access to care to more than 1,800 outpatient clinics. 

How to Cite This Paper:
Massoud MR, Nielsen GA, Nolan K, Schall MW, Sevin C. A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006. (Available at ihi.org)