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Spread: Widening the Adoption

After the “A” in PDSA, you will measure the results of the change and decide whether to adopt the change or reject it. It may be time for another PDSA cycle or time to incorporate the gains and spread the change throughout your system.

The Process Owner is the person who will continue to monitor the changes, periodically collect more data, and attempt to hold the gains.

We have studied the Cultural Side of Change, with innovators, early and late adopters, laggards, and people who will never adopt change. Our major tool in anchoring change is using knowledge in the spread of ideas: what is the improvement, why does it work and where is the data for that? Share your PDSA thinking. Persuasion ties the information to the individual’s need structure–WII-FM (What’s in it for me?). How can you enhance their personal benefits over their cost of change?

The concept of homophily suggests that people believe others who are like them, so peer-to-peer communication is very powerful. We also know from the change literature that “social support” enables the change to stick.

Langley, Gerald J., Ronald Moen, Kevin M. Nolan, Thomas W. Nolan, Clifford L. Norman, & Lloyd P. Provost (In The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass, 2009) offer these ideas about anchoring change:

  • Standardization (of the change)
  • Documentation
  • Measurement
  • Training
  • Periodic Self-Audits

Jim Handyside (Improvision Healthcare Inc.) shared these ideas about the Spread Process. To prevent backslide, we need to keep the vision alive, enhance the benefits, and reduce the pain of changing. Also, some reminders for the change are to make it:

  • Conspicious – able to catch attention at a critical time
  • Contiguous – as close as possible in time and space to the necessary action.
  • In Context – provide information about the when and where of the item to be remembered.
  • With Content – provide sufficient information about what has to be done.
  • Countability – allows a count of the number of actions that need to be done.