Welcome to this session on Spreading Innovation, Sharing your Learning. I'm Melody Malone, a Quality Improvement Consultant with TMF Health Quality Institute, and very pleased to be giving you this presentation today. When we talk about spreading our innovation, you can think about this on many levels. You could spread throughout your nursing home, throughout your community of practice, such as your referring hospital, and throughout your company. You may also have ways to spread change throughout the nursing community through the forum on the TMF website. Now, the Spread Model is something we're going to be moving to, and as we move to the Spread Model and as we learn from our data, we must never forget that every resident, every visitor, every guest and every staff member matters. Our quality improvement efforts that we want to spread may actually hurt someone. So we want to always keep that in mind. And as we move into talking about spread, this model may look very complicated to you. But I want you to think about it, it's something you do every day. Spread is the adoption of better ideas communicated through our social system. And we do that all the time with texting and Facebook and Pinterest and LinkedIn and blogging, and even the forum on the TMF website. So we use our social systems all the time to spread ideas. But in our case of quality improvement, in addition to using our social system, this is supported by an organizational infrastructure. The concept of better ideas includes making the case for the new ideas, though what's in it for the stake holder, or what's in it for me and how this new system actually works. What exactly does the new system look like? And then, all the tools and materials that may have been developed by your quality improvement team that's going to help new groups adopt these changes. So, that's in your better ideas. And this way of doing things, this new way of doing things, is communicated through a number of different modes or channels. We've already talked about some of those and they may also include newsletters, meanings, one-on-one conversations, in addition to texting, Facebook, and Pinterest, and it involves a broad awareness of the new system. And the technical information that's needed by new groups that are ready to adopt these changes, the purpose and the how. And remember this communication is really communicated through key messengers. Often times, these are going to be members of your quality improvement team, or someone else from the system who is very knowledgeable about the changes. People that are excited about what you're doing, about the change that's happened; and ideally these key messengers are also very respected by their peers and whose opinions have credibility among these new groups where this spread is going to take place. These new groups where the spread is going to take place will consist of people who also have social connections with one another. But everybody varies in their readiness to adopt the new system. Those who are in the organization will guide this third process by staying in touch with the issues, and concerns of those in the new target group are the listeners and connectors. Listeners and connectors in this social system work to link those with similar positions and interests in the communities of practice, where peer-to-peer communication about the why and the how to adopt this new system can best occur. This whole process is supported by this infrastructure that includes leaders who are responsible for spread, and there should be a strategy for reaching out to those new target units in the organization you want to spread the material to. There should be the technical support, the materials, the resources, the experts available about how to make the changes. And a way to continually build knowledge about the new system as it spreads within and without the organization. And of course we always want to have a measurement system to monitor the extent and the scope of the spread. Wouldn't it be great to know how far your idea that worked in your nursing home spread throughout the world? Now, all of this sounds really kind of half [inaudible], but this is just what we do on a natural basis anyway. We are always spreading better ideas; we're communicating them through a variety of modes, while utilizing our social system. So don't make it harder than it has to be. But you do have to decide what are we going to spread, to whom, or where are we going to spread it, when, and how are we going to spread it. So let's talk about those. So what are you going to spread? Well, you may spread a single change. Like maybe, you're going to trial hip protectors in your nursing home, or resident-specific care cards that have really worked great, and so you're just going to change that one spread. Or you may have made an entire redesign of an interdisciplinary care process that you're going to spread to help you with [inaudible] of prevention. Or maybe you're going to help spread the model for improvement and continuous quality improvement methodologies. You've just got to decide what is it specifically that you're going to spread? Then, you've got to decide to whom and or to where are you going to spread. Now that's pretty easy, because there's lots of community out there that's waiting for great ideas. And spread is important because, think of it, any improved care we're providing to elders is going to help improve all elders, and any improvements that we make can help the image of long-term care and don't we want the overall image to improve? You bet we do. We sort of have a society that assumes if one is guilty, therefore, all are guilty. Or if something is wrong with one facility in a corporation or a group, the same sort of rest on all right? So if we're generous in our sharing, like on the TMF website, and use the discussion threads, then we can take pride that more facilities are coming in line with current best practice and that the overall image of long-term care will improve. And you never know, we might feature you on a website on a webinar. So when are you going to spread? Well, you want to have this clear expectation from the start that ultimately you're going to spread your improvement. But you do it once you do have this very clear message from senior leadership that we have this organizational goal to spread. Leaders of the spread effort organize kind of your source documents that you're going to use or this spread package that helps explain the new system by using maybe multiple levels of explanation, tools, and resources. Your senior leader aligns the clinical and operational structure and provides this unified leadership for spread. You want to spread when your team is self-sufficient. You want to make sure you're really ready for spread, that your idea is strong, because we absolutely want no failures in spread. We want to make sure we work through our processes, our tools and resources are strong and robust and support our change effort. So we communicate the strategic importance of the improvements in various ways to the organizations we're spreading to. And that may include prominent placement in the organization strategic plan, system-wide messages or publications, or website content, leadership meetings and organizational events, or endorsement from the board or the governing body of your organization about when it's time to spread. Now, how can we spread the innovation? Well, thankfully, others have gone before us. This idea of spreading innovation or diffusion of innovation has been studied throughout this last century. The science of diffusion of innovation or spread mirrors developments in behavioral science. The following tools and guidance have been drawn from the thinking of API, IHI, ICIC, and references are given at the end of the presentation. In addition, many of you are already experts in spreading ideas. You do it naturally, texting, Facebook, LinkedIn, the TMF forum, but when you're thinking about spreading and adoption of innovation, there actually is this model for categories of adopters. There's the innovators, the people like you that are out there creating new ideas, new ways of doing things, making improvements. Then, there's the early adopters that jump on board. Then, we have an early majority and a late majority, and then the traditionalist or laggards that are slow to adopt and as you think about your own adoption of new ideas how do you actually fit into this? Now think about yourself. Did you go out and get the brand new smart phone right off the shelf as soon as it was in? I mean, it really didn't even sit on the shelf? Or are you kind of holding back? That may be an indicator of how you adopt the technology changes. Doesn't mean that that's how you're going to adopt to everything, but it's a way for you to even think about yourself. Where did you fit into technological innovation? So, as you go along and as you're looking at your quality improvement efforts, remember not everybody's going to adopt at the same time. We're always going to see this model of innovators, early adopters, and then laggards. But the framework for spread can, maybe for you, this will help you with this mental model. I want you to look on this right side. The key is your social system. What is your social system that you're going to use to actually spread those ideas? So, as you're working on the left-hand side where you're working your model for improvement, your ideas are being generated, you're working the quality improvement process and you develop this spread package. So that's your ideas and then your set-up. Then you go out into the social system, and it might be things like Nadonna [assumed spelling] or THCA or leaning age, or what about a different nursing association or therapy association. Maybe, it's the hospital association, or the Texas Association for Health Care Quality. You may spread your ideas throughout a variety of groups. You are pushing out your learning to others, because you've become a learning organization. And when we look about spreadable ideas, keep in mind, you've always got to make that case. Why would others want to make these changes? What makes it good for them? What's in it for them? You'll always have to describe those changes, so whatever your change concept or change package might be, and then make sure you have all of those transition materials to help others make it work. So, your great ideas can be very spreadable, you just have to package them in such a way that you can push them out to the community. And remember, you can share that information or shape those new behaviors for adoption through virtual message, face-to-face, at their facility, or maybe they need to come to your facility and see how you're actually doing it. And then there's always got to be that purpose, that awareness of technical knowledge that we've got to communicate in order for spread to actually work. Your social system is always those that you're spreading it to, and remember you're always going to have those key messengers that you will rely on to spread the word. Remember those listeners and connectors that are out there in that social network that are really trying to make it happen. They're really resolving issues, they're helping people overcome any fears or biases or barriers to these changes. They're the ones that are helping make it work. And as you move into these communities of practices, you're going to identify groups that can be used to facilitate change. Remember, in every group, you're always going to have those innovators, the early adopters, the early majority, the late majority and the laggards. You're always going to have that group. So you're going to find people that you can use that can facilitate the change. But keep in mind, there's always got to be some kind of stimulus to help people decide it's time for them to ask. And you may have to help that motivation and help them identify incidents for their team to take on this project with you. And flexibility is so important, and we have to help people understand that change can be done and that we can make this work. So keep in mind, in that infrastructure, there's always got to be a staging plan for you to figure out how are we going to reach all units over time. And then where is that technical support? If you're spreading out, let's say to your corporation, do people know where they can go to ask questions? Do people know how they can find that learning that they need in order to adopt this change and then with all of our quality improvement efforts, we always want to have measurement and feedback, so we can identify how we can do this better next time. Because, even though your quality improvement project may have achieved your gains, your holding, you've hard-wired your system and now you're spreading out for the rest of the community, you want to measure your spread strategy, how well, how far, how deep did you reach? Because that will help you the next time you go to spread. I mentioned to you earlier there are many that have gone before us that have really helped organizational science and have helped in the whole diffusion as innovation. I want you to make sure to take advantage of the references and help your team learn how to spread ideas for quality improvement. It's so important that we become a learning organization. And you can help do that by posting ideas, or adding responses to the forums on the TMF website. I invite you do join the discussion and share your quality improvement journey, your learning, and especially your plan. So what is your plan? How are you going to spread your innovation within and outside of your organization? I encourage you to think about that even at the beginning of your quality improvement project. As you implement that first team, how are you going to spread your plan? Feel free to reach out to us if we can help you in any way, on our website, our phone number or by email. We're here to support you. Thank you.