Spread is Not Butter

Theresa Fillatre Atlantic Node Leader

October / November 2007

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Herding Cats

VIDEO

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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

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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

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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

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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

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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

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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)

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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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Thank You !

Theresa.fillatre@cdha.nshealth.caPhone: 1-902-221-4719