Once you have refined your ideas through PDSA testing and your measures are showing improvements, it's time to think about how to embed and sustain these into business-as-usual processes. 

We often find when the focus is not on a new idea, things can easily slip back into the old ways of working and gains are not sustained.

When planning, testing and implementing change, consider these areas to help integrate and sustain new ways of working within the system and infrastructure:

Scale up and spread  - new sub link 

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.  

Successful spread needs to be approached strategically to ensure gains are not lost. Here are some tips for successful spread:

• 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?

• 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

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)

Psychology of change