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 There are three types of expertise and/or responsibility that should be considered in forming a spread team: senior leadership, day-to-day leadership, and technical expertise (i.e., knowledge of the changes that are being spread, and some understanding of the components of an overall strategy to support spread.) There may be one or more individuals on the team with each kind of expertise, or one individual may have expertise in more than one area, but all three areas should be represented in order to drive improvement successfully.
Senior Leadership
It is the responsibility of executive leaders to ensure that the spread aim is aligned with the strategic goals of the organization and to assign day-to-day leadership for spread. Executive leaders provide overall guidance to the spread team and ensure communication and involvement of senior leadership in the progress of the spread effort.
Spread Team
A spread team is the group of people established by the organization's executive leaders that works closely with executive leaders to provide direction for the spread effort and monitors progress in meeting the organization's spread goals. Depending on the changes being spread, several areas of expertise and/or responsibility should be considered for a spread team: the designated senior leader; a day-to-day leader of the spread activities; and others, including line- or department-level leadership; clinical expertise; representatives of a successful pilot site; those who will lead the effort in the target population; and support services such as information technology, human resources, and quality improvement. |
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Example 1: Patient Safety
What we intend to spread:
We will spread a safe, efficient, and effective medication system that includes the following key components:
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Executive WalkRounds
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Unit briefings
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Reconciliation of medications
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Use of Failure Modes and Effects Analysis (FMEA)
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Focus on high hazard medications
Aim (target levels of system performance):
We will reduce adverse drug events (ADEs) in our hospital from an average of 30 percent of patients experiencing an ADE to less than 5 percent.
Small System (e.g., within one hospital) — Target population for spread:
We will spread our new medication system from one medical/surgical unit to all inpatient units in our hospital.
Spread Team
Senior Leader: Vice President of Medical Affairs
Day-to-Day Leader: Patient Safety Officer
Others with Clinical and/or Technical Expertise: The team leader from the pilot unit (pharmacist, nurse manager, risk manager, or quality officer; nurse manager for each of the target units
Large System (e.g., 30 to 35 hospitals) — Target population for spread:
We will spread our new medication system from all inpatient units in one pilot hospital to the other 35 hospitals in our system. In the next 12 months, we will spread to 10 hospitals in the same region as the pilot hospital. In the second and third years of this spread effort, we will bring the remaining 25 hospitals in our system into the initiative.
Spread Team
Senior Leader: Corporate Vice President of Medical Affairs
Day-to-Day Leader: Corporate Patient Safety Officer
Others with Clinical and/or Technical Expertise: The team leader from the pilot hospital (pharmacist, nurse manager, or quality officer); a pharmacist, nurse manager, risk manager or quality officer from each of the target hospitals
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Example 2: Access in Physician Offices and Clinics
What we intend to spread:
We will spread a timely and efficient office practice system that eliminates unnecessary delays in patients obtaining care. The new system includes the following components: work down the backlog, reduce demand, reduce appointment types, understand supply and demand, plan for contingencies, optimize the care team, manage the constraint, and synchronize patient, provider, and information.
Aim (target levels of system performance):
As a result of our efforts, will be able to promise patients care that is timely and efficient and that meets the following target levels of performance:
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Same-day access to their primary care physician
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Access to specialists within two days
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Less than 15 minutes waiting time to see a physician at the time of the office visit
Small System (e.g., six sites) — Target population for spread:
Within the next year, we will spread access and patient cycle time improvements from one primary care clinic to our five specialty clinics.
Spread Team
Senior Leader: Medical Director
Day-to-Day Leader: Director/Practice Manager (with technical expertise in improving access)
Others with Clinical and/or Technical Expertise: A physician and nurse manager (and/or other team members) from the pilot clinic; the practice manager from each of the target sites; a physician and nurse leader from each of the target sites
Large System (e.g., 50 to 60 sites in four regions) — Target population for spread:
Within the next year, we will spread access and patient cycle time improvements from one primary care clinic to the other five primary care clinics and the three multispecialty clinics in
our region. During the second year of our spread effort, we will spread access and patient cycle time improvements to the 50 primary care, specialty, and multispecialty practices in our other three regions.
Spread Team
Senior Leader: Chief Medical Officer
Day-to-Day Leader: Director of Service Performance for the system (with technical expertise in improving access)
Others with Clinical and/or Technical Expertise: A physician and nurse manager (and/or other team members) from the pilot clinic; the clinic administrator/director responsible for each region; a physician or nurse leader from each of the regions |
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Example 3: Chronic Conditions
What we intend to spread:
We will spread a new way of delivering care for our diabetic patients that improves patient quality of life and clinical outcomes. We will use the Chronic Care Model to delay and decrease complications from diabetes, ensure self-management, build decision support systems, redesign our delivery system, and become a center of excellence in our community.
Aim (target levels of system performance):
Our target levels of system performance for diabetic patients include:
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90 percent of patients with two HbA1cs, three months apart, in 12 months
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70 percent of patients with a self-management goal
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95 percent with lipid profile annually
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70 percent with LDL < 130
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95 percent assessed for smoking
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100 percent of smokers counseled to stop
Small System (e.g., six sites) — Target population for spread:
Our spread plan has two phases. Within the next 12 months, we will spread a new way of delivering care for our diabetic patients from one clinic to the other five clinics in our community health system. During the second year, we will spread our new care model to encompass all of our patients with chronic diseases, including those with asthma, coronary heart disease (CHD), and depression, as evidenced by appropriate measures of clinical effectiveness for each condition.
Spread Team
Senior Leader: Medical Director
Day-to-Day Leader: Director of Service Performance/Quality Improvement (with technical expertise in the Chronic Care Model)
Others with Clinical and/or Technical Expertise: Physician and nurse manager (and/or other team members) from the pilot clinic; the practice manager from each of the target sites; a physician or nurse leader from each of the target sites
Large System (e.g., 50 to 60 sites in four regions) — Target population for spread:
Our spread plan has two phases. Within the next 12 months, we will spread a new way of delivering care for our diabetic patients from one clinic to the other five clinics in our community health system. During this same period in our pilot clinic, we will expand our care model to include patients with asthma, coronary heart disease (CHD), and depression, as well as those with diabetes (as evidenced by appropriate measures of clinical effectiveness for each condition). During the second year, we will spread our new care model for all patients with chronic disease to the other 25 clinics in our system.
Spread Team
Senior Leader: Chief Medical Officer
Day-to-Day Leader: Director of Service Performance/Quality Improvement (with technical expertise in the Chronic Care Model)
Others with Clinical and/or Technical Expertise: Physician and nurse manager (and/or other team members) from the pilot clinic; the clinic administrator/director responsible for each region; a physician or nurse leader from each of the regions |
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For more general information on forming improvement teams, see the Improvement Methods section.
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