The Science of Spread: How Innovations in Care Become the Norm

This 25-page report from the California HealthCare Foundation explains why the spread of improvements in health care organisations is distinctly different from the diffusion of innovative ideas in other areas of life. It summarises some of the thinking within the emerging science of "spread" (or innovation diffusion), and provides case studies of health care organisations that have achieved some degree of success in spreading change within organisations.

The author reviews a number of sources whose ideas on health information diffusion include:

• A communication channel must exist through which the innovative idea is transmitted.
• The structure of the social system can facilitate or impede diffusion of innovations.
• The individuals involved in spreading innovation matter, and might be a top executive with the power to make changes.
  
• Message "stickiness" is important. A communication strategy for sending clear messages through effective channels is important.
• Measurement and evaluation of diffusion are important.
• A tipping point for health care innovation is argued to be 10-20 % of the intended population group.
• Tactical arguments must be different for those who are conservative about change and those who are eager for change.
• Spreading health care innovation should reduce costs, not increase them, so that the organisation spreading the innovation benefits. Those providing care may also benefit from more efficient working circumstances, which will increase their willingness to adopt innovation.

Critiques of "spread" attempts include:

• Pilotosis, where a small number of people benefit from innovation at increased cost or with extra personnel.
• "Low-hanging fruit syndrome" in which a population of patients who improve easily, not a representative population, are selected for trials.
  
• Innovations are pushed as universal solutions, not situation-appropriate solutions.
• The tipping point is higher than originally argued - even higher than 20-25%.
  
• Leaders must be active, curious, passionate, and consistently leading, particularly using the active verb "implementing" rather than the concept of "spread".

The author uses case studies to show how ideas have spread in health care systems. An example is the advanced access system now employed throughout the Veteran's Administration medical system in the United States. It is reported to give patients faster access to care, particularly those patients with chronic conditions who benefit from immediate management. The key change strategy to bring in innovation was to have local leaders take on a task and champion it.

The author concludes that while the tipping point concept is often not true for health care organisations, the case studies and scientific literature have lessons for these organisations. Lessons include the use of senior management leadership, champions as enthusiasts for beginning adoption of innovations, idea selection from frontline workers, and balancing micro- and macro-system changes.