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.  Since then, IHI's Framework for Spread has continued to evolve. This white paper provides a snapshot of IHI’s latest thinking and work on spread.

The paper is divided into two parts.  The first part of the white paper describes the major spread projects that IHI has supported through early 2006 and harvests the lessons IHI has learned about the most effective ways to prepare for spread, establish an aim for spread, and develop, execute, and refine a spread plan.  The second part of the white paper is a reprint of an article published in the June 2005 issue of the Joint Commission Journal on Quality and Patient Safety, describing 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.

This white paper may be downloaded without charge from the IHI web site. Users must first register with the IHI site; registration is free. Once logged on to the IHI web site, A Framework for Spread can be downloaded free of charge at http://www.ihi.org/IHI/Results/WhitePapers/AFrameworkforSpreadWhitePaper.htm.