A Spread Approach

1
A Spread Approach

• Kelly WestfallQualis HealthNNHIC Coached
  Practice 2
• January 14, 2004

2
Objectives

• Briefly review IHI model for spread
• Describe an approach to spread
• Facilitating communities of practice for spread
• The PUSH PULL dynamic

3
A Framework for Spread
Source IHI, 2003
4
A Framework for Spread
Source IHI, 2003
5
Approaches to Spread

• Natural and spontaneous diffusion of innovation
• Planned diffusion of innovation
• Top-down directive
• Facilitated communities of practice

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Facilitated Communities of Practice

• Principles and underlying assumptions
• Key activities of the spread agent

7
Principles and Underlying Assumptions

• Use Principles of Adult Learning
• Adults expect it to be relevant
• Adults have life experiences and knowledge
• Adults learn best when actively engaged
• Adults want practical knowledge
• Adults want an environment that is safe,
  engaging, informal and respectful

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Principles and Underlying Assumptions (contd)

• Use natural selection of early adopters and early
  majority
• Share and learn from all ideas
• Support spread as a continuous staged process
• Diffusion of Innovation Curve is dynamic, not
  static
• Change happens when individuals take action
• Develop systems to support changes

9
Key Activities

• Initiate the community of practice
• Facilitate the community of practice
• Identify the communicators and connectors

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Initiate the Community of Practice

• Communicate awareness
• Identify those interested and ready to act
• Communicate the ideas, successes and lessons
  learned

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Facilitate the Community of Practice

• Nurture natural workgroup learning
• Facilitate peer-to-peer learning
• Enable those who want to change
• Be aware that requirements and structure in the
  CoP may have a negative impact
• Appeal to self-interest
• Enable dialogue to stimulate improvement
• Decrease activity of the facilitator

12
Identify the Communicators and Connectors

• Create an interconnectedness map
• Determine the trust network
• Determine the advice network
• Adjust these networks as the community of
  practice grows

13
The PUSH PULL Dynamic
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The PUSH PULL Dynamic
Make it happen
Let it happen
Dissemination High control Interventionist Does
it work for everyone? Does it value
diversity? Does it recognize social structures?
Diffusion Low control Non-interventionist Each
setting is unique Difficult to maximize
impact How legitimate is the practice?
Source S. Fraser, 2003
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Suggested Next Steps

• Identify the push and pull elements of spread
  plans
• Evaluate the balance between push and pull in
  spread plans
• Identify potential communities of practice