A measurement system for spread includes two sets of measures:

• The main outcome measure(s) of the process or system of interest
• The rate of spread (of a specific change)

As in any improvement effort, a spread project must be focused on improving outcomes — e.g., reducing adverse drug events, reducing hemoglobin A1c levels, or reducing waiting time. When spreading a particular change, the rate of spread of the change across the organization is an additional key measure. For example, an outcome measure for a project focused on spreading an ideal medication system would be the rate of adverse drug events over time. In addition to assessing progress based on this outcome measure, it is important to assess the rate of spread of the change concepts and specific ideas that support the improvement being spread.

Spread Outcome Measures

Outcome measures tell you whether changes are actually leading to improvement — that is, they assess the impact of spreading a specific improvement that has been achieved in a pilot hospital/site to additional hospitals/sites within a system. An example of an outcome measure for a spread project focused on spreading an ideal medication system is "the rate of adverse drug events in the XXX hospitals/sites involved in the spread effort."

Rate of Spread

Along with identifying key outcome measures, it is important to collect information on the rate of spread of specific changes. For example, in a project focused on spreading an ideal medication system, a key change for supporting spread would be the use of "unit briefings" to help identify unsafe situations and opportunities for reducing harm associated with medications. An example of a measure of the rate of spread of this change is "the rate of spread of unit briefings across the XXX hospitals involved in the spread effort."