Tips for avoiding the BIGGEST waste of all...FAILURE TO SPREAD that great idea, innovation, improvement, or practice!

1. Choosing Your Methods for
Spreading Improvement
Gerald Linnins

2. Learning Outcomes…
• State the key elements of a successful
Spread effort
• Identify methods for Spread
appropriate to the change being
considered
• List barriers to successful Spread and
methods for overcoming those barriers
• Identify two key concerns that
frequently impact stakeholder and
team engagement and their potential
to impact your Spread efforts
2

3. Where You SHOULD be IF You Are Considering
Spreading Your Idea, Innovation, or Improvement
• Clearly defined your original performance problem
• Developed an appropriate Improvement Intervention
• Tested your intervention through several PDSA
• Decided to Adopt/Adapt your intervention
• Implemented your intervention in the target area(s)
• Measured/Monitored/Continuously Improved your intervention
• Sustained the gains your intervention intended to achieve
• Assessed readiness to Spread AND readiness to receive at target site(s)
• Developed a well-defined, documented Change Package
• Ready to develop a comprehensive Spread Plan with stakeholders and target(s)
7 out of 10 Change
Initiatives Fail or Fail
to Sustain Longer than 6
Months!

4. The IMPROVEMENT GUIDE contains
an Appendix (Appendix A: A
Resource Guide to Change
Concepts) that describes in detail
how 72 change concepts can be
used to create ideas for testing
The Type of Intervention Affects the Spread…

5. 5 Stages of Adoption*
1. Knowledge
2. Persuasion
3. Decision
4. Implementation
5. Confirmation
*based on work of Everett Rogers
KEY DRIVERS of Adoption: Safety, Quality,
Affordability, Delivery, Morale

6. Two Key Challenges to Spread…WIIFM!*
**WIIFM – What’s In It For Me?!!!
Discretionary Effort Normal, “Healthy” Resistance to Change

7. What is YOUR APPROACH?
Let It
Happen
HELP It
Happen
Make It
Happen

8. 1. EXPERT (“Hired Gun”)
2. “ORDER TAKER” (Delegated)
3. PAIR OF HANDS (Worker Bee)
4. COLLABORATOR (Peer/Partner)
5. FACILITATOR (Process Guide)
WHAT IS YOUR ROLE?

9. Readiness Assessment…Be Brutally Honest!
READY TO SPREAD?
• Does it work? (it’s a scale!)
• How does it work?
(defined/documented)
• Where else can it be
implemented?
• Likelihood of spreading?
READY TO RECEIVE?
• Does the idea, improvement, innovation
have organizational support and
sponsorship on the receiving end?
• Does it enhance organizational
effectiveness, efficiency?
• Is there infrastructure in place to support
implementation?
• Is there staff/leadership/resource
capacity to support implementation?

10. Let Your Assessment Guide Your Approach to Spread
• JUST DO IT
• Go fast, replicate with little variation
• TEST & REPLICATE: DIFFUSION
• Implement in a few sites to increase level of agreement
• Spread slowly with minimal coordination
• TEST & REPLICATE: COLLABORATIVES
• Infrastructure
• Accountability
• Learning
• Sharing to create the Change Package
• TEST & REPLICATE: PHASES OR WAVES
• Pilot in 1-3 sites, spread to 5-10, then to all sites
• Highly coordinated and planned progression of spread
• Build WILL and transferability of practice in early sites
• INNOVATE:
• Go slow, prototype, replicate, refine, and then spread
It Depends…

11. APPROACH 1: DIFFUSION
1. CONTAGIOUS – Spreads rapidly throughout the target population or
site due to high need, low resistance, or perceived value. It is a
“natural” spread that does not usually require a lot of oversight
2. HIERARCHAL – spreads because it is imposed or “driven” by a person
in authority (real or perceived); often driven by “position” power or
“personality” power
3. STIMULUS – spread of a principal that is accepted but not necessarily
a specific practice; may buy into reason or evidence but not the
selected spread tactic (This is where “local customization” often
happens!)
4. RELOCATION – Physical removal, reassignment, or addition of people,
technology, etc. to support the spread concept/package
implementation

12. APPROACH 2: COLLABORATIVES
The approach and Change
Package are created within the
project, spread or
implementation team through
a series of iterative learning
events or a single intensive
event

13. APPROACH 3: WAVES
Spreading in WAVES often follows the classic
PDSA model in that the change is spread on a
limited scale, measured-monitored-improved,
and then spread to additional teams/sites
according to an agreed upon plan or
schedule.
TIP: Using people from the “next in line” site
can enhance their comfort level, their
competency, and their commitment to the
change(s) being implemented.

14. APPROACH 4: INNOVATE
• Creativity
• Psychological Safety
• Time
• “Non-Negotiables” Clearly
Identified
• Facilitation
• Comittment to Adopt
• Ability to say, “No,” “Whoa,” AND
“Yes!”

15. 1.Create urgency
2.Form a powerful coalition
3.Create a vision for change
4.Communicate the Vision
5.Remove obstacles
6.Create short term wins
7.Build on the change
8.Anchor the changes in
corporate culture
CHANGE: Kotter’s Model

16. HARDWIRING YOUR CHANGE

17. REMEMBER, to Spread Effectively…
S P R E A D
SELECT PLAN READINESS ENGAGEMENT ACTION DECISION-
MAKING
The reason, criteria,
desired benefits from
spreading this
particular idea or
practice?
Target Site(s)
Impact?
Difficulty?
Urgency?
Emergent or
Intervening Influences?
5W&H?
• What?
• When?
• Where?
• Who?
• WHY?
• How?
Is your plan fully
thought out and
is the target site
capable of
implementing
your plan as
designed?
Environment?
Good at change?
Capacity?
Leadership?
Temperature?
Are all necessary
roles and
responsibilities
covered?
Has spread effort
been properly
communicated and
socialized?
Has clear
ownership
established for
sustaining after
Spread?
Is your plan
SMART?
Are all key
stakeholders
clear on their
roles &
duties?
Is everyone
clear on how
to escalate
concerns?
How will decisions
be made going
forward?
How will you
communicate
(RACI)?
What review
process for the
Spread activities
will be used?
Is there alignment
as to what SUCCESS
looks like?

18. • DANCE OF CHANGE FIELDBOOK –
Peter Senge
• CHANGE OR DIE – Alan Deutschman
• HELPING – Edgar Schein
• JOINING TOGETHER – David and Frank
Johnson
• CREATING A CULTURE OF
COLLABORATION – IAF Handbook
Besides those cited in the previous slides of this
presentation, my “GO TO” resources include…

19. THANK YOU!
Gerald Linnins
jlinnins@yahoo.com