If your changes are leading to sustained improvements, it may be appropriate to scale up and spread these more widely to other wards or teams within a service. By increasing the number of teams testing new ways of working, the changes will be further refined as they are tested in different environments, overcoming infrastructure or system challenges. 

Once proven interventions are established, it may be appropriate to spread more widely, consistently embedding new ways of working across all applicable settings within the system. However, successful spread needs to be approached strategically to ensure gains are not lost.

Top tips for successful spread 

• Don't spread too quickly
• Don't rely on one individual to spread and sustain
• Don't rely solely on vigilance and hard work to sustain gains
• Don't spread success too rigidly
• Don't check data once a quarter

• Create a reliable process before you start to spread
• Use PDSA ramps to see how changes work in a different service or setting before rolling out more widely
• Make sustaining gains a team effort
• Make sure the appropriate team is tasked with wider organisational spread - this may not be who initiated the original project
• Establish infrastructure to sustain and embed improvements
• Allow controlled customisation, so long as core elements are clear
• Check data regularly to inform how you adapt and spread
• Establish accountability for on-going quality control measures

The IHI has created the Seven Spreadly Sins - top tips of what not to do! Can we link to this? do we need permission first?

lots of good resources here... worth linking to rather than recreating?

Scale-Up and Spread - Quality Improvement - East London NHS Foundation Trust : Quality Improvement – East London NHS Foundation Trust (elft.nhs.uk)

Should this have a sub-heading of its own? lots more info could be included...

The human side of change is often the most challenging - understanding the psychology of how change is experienced can help us support those affected understand and adapt to new ways of working.

Resistance to change is often about losing the way things were, which can generate emotions of fear, denial, anxiety and uncertainty; in fact, psychologists liken the experience to the stages of grief. In order to support people through change, resistance should be treated as something to understand rather than overcome.

• Help people understand - what problem will the change solve and how?
• Acknowledge the impact - consider what the change means to different people
• Replace fear with excitement - what's in it for them?
• Be respectful - criticising the old way of doing things can be insulting or demotivating
• Create a shared vision - empower and include people to create ownership over change
• Build momentum - use quick wins to demonstrate the positive impact
• Adapt your engagement approach - does your audience respond to data or narrative?
• Use 'social proof' - people who are already engaged can influence their peers