Open School

IHI Open School Course Summary Sheet:

QI 201: Planning for Spread: From Local Improvements to

System-Wide Change
(Visit www.ihi.org/education/ihiopenschool/courses to learn more.)

Lesson 1: How Change Spreads

 Psychologist Kurt Lewin proposed that organizational change happens in three

phases:
o Unfreezing: Loosening the attachment to the current behavior or practice
o Change: When the process of change actually occurs
o Freezing: Making sure the change can continue to operate as designed
 Sociologist Everett Rogers said for any given change or innovation, there are five
categories of adopters:
o Innovators are always ready to try the latest, greatest thing, often even
when there’s risk involved.
o Early adopters aren’t as venturesome as innovators but are among the first
ones willing to try the idea.
o Early majority adopters of an innovation indicate the stage at which the
masses begin to accept it.
o Late majority adopters can be seen as skeptical about a given innovation.
They may be driven to adopt the change out of economic need, peer pressure,
or policy, rather than personal interest.
o Laggards may take a long time to understand and accept an innovation.
They’ll adopt the change only because they have no other alternative.

Lesson 2: Tactics for Spreading Change

 Sociologist Everett Rogers identified five characteristics of ideas that spread:

o Relative advantage
o Compatibility
o Simplicity
o Trialability
o Observability
  Based on the characteristics of spreadable innovations, improvement teams can use a
New Idea Scorecard to assess the ease with which a change is likely to spread.
 IHI’s Framework for Spread identifies seven components for large-scale spread:
o Leadership: setting the agenda and assigning responsibility for spread
o Setup for spread: identifying the target population and initial plans
o Better ideas: describing the new ideas and evidence for them
o Communication: sharing awareness and technical information
o Social system: understanding the relationships among people
o Knowledge management: replicating successful spread efforts
o Measurement and feedback: collecting and using data about process and
outcomes to monitor and make adjustments to the spread progress

Lesson 3: Case Study in Spreading Innovations: Transforming Care at the

Bedside

 Seton Family of Hospitals in Greater Austin, Texas, participated in the early stages of
an innovative program from the Robert Wood Johnson Foundation (RWJF) and IHI
called Transforming Care at the Bedside (TCAB).
 By following IHI’s Framework for Spread, Seton Family spread the TCAB approach
from an initial medical-surgical pilot unit at Seton Northwest Hospital to 21 units
across eight hospitals in their system.

IHI’s Framework for Spread identifies key components to consider

when developing and executing a spread strategy.

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