Spread takes a change that has worked in one context and introduces it into another. IHI emphasizes that the adopting team still needs to test, adapt, and implement the idea. Sending a successful project's slides or policy to another unit is therefore a starting point, not completed spread.
When planning scale, specify the intended reach: more patients, more shifts, more units, or an entire organization. Using a concrete scope is more useful than assuming everyone means the same thing by a large-scale rollout.
Describe what actually produced the improvement
Before approaching another team, prepare a concise account of the problem, the change, the evidence, and the conditions in which it was tested. Distinguish the essential function from local details that may be adaptable.
A form may be the visible artifact, while the important change is an agreed handoff, a new responsibility, or reliable access to a resource. Copying the form without that support may reproduce the appearance of the project without its intended function.
IHI's spread guidance identifies leadership, planning, communication, measurement, and feedback as important components. These are resources to arrange, not tasks that can be assumed to happen because another unit has been told to adopt the change.
Learn the receiving team's context
Ask the new team how its patients, workflow, technology, staffing arrangements, and dependencies differ. Include people who will perform the work and people who receive its output. Agree on what can be adapted and how changes will be documented.
A phased approach can expose problems before the change reaches the whole service. The receiving team should define its own test questions while preserving the clinical purpose of the original work. Additional testing is especially useful when the new setting introduces conditions the first team did not encounter.
Illustrative transfer between units
An illustrative unit improves availability of patient-education materials by preparing them during a scheduled morning planning step. Another unit wants to adopt the idea, but its admissions occur throughout the day and have different preparation needs.
The receiving team keeps the aim of timely, usable materials but tests a different trigger for preparation. It measures availability and patient usability rather than insisting on the same meeting time. The example does not establish that either method will work; it shows the distinction between preserving function and copying every detail.
Measure adoption and benefit separately
Training attendance, participating units, and use of a form describe implementation activity. They do not by themselves establish better care. Track the intended outcome and relevant burdens alongside the extent of adoption.
Document which sites and patients are represented in the results. A strong result in early volunteer units should not automatically be presented as the outcome across the whole organization.
Spread also needs a maintenance plan. Identify who supports later adopters, shares emerging problems, and updates the change when new evidence appears. Wider reach is worthwhile only when the process remains useful in the places it reaches.
For testing whether an approach fits a new unit, see small tests of change.
Related
Sustaining Nursing Practice Changes
Sources
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IHI: Spreading Changes (accessed 2026-09-17).
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IHI: Implementing Changes (accessed 2026-09-17).
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IHI: Establishing Measures (accessed 2026-09-17).