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Spread and Diffusion


One of the main problems faced by quality improvement initiatives is that they too often remain as localised pockets of excellence without spreading beyond their original boundaries.

Given the current climate, where financial constraints are pushing organisations to make the best use of their resources, having a better understanding of the factors affecting spread and diffusion has become of strategic importance.

Tools and resources

There are a number of guides and tools available:

NHS spread tool

A practical tool has been developed by HNS Institute (no longer in existemce) represents what we know about spread and adoption. It is still accessible via the link below and it will help you increase the scale and pace of the spread and adoption of innovation in the NHS.

Find out more here.

Further information

Summary of resources and research

A guide has been developed by Healthcare Improvement Scotland to summarise the existing resources and key pieces of research around spread and sustainability. The aims of this guide are:

  • to increase the understanding of the key issues around spread and sustainability
  • to signpost readers to existing valuable resources on these topics
  • to assist quality improvement practitioners in the process of planning for spread and sustainability of improvement and its implementation and
  • to advise supporting organisations on initiatives that could facilitate spread and sustainability of improvements at a national level.

Find out more here.

Communicating and publishing

There is a lot more to be done to share and spread innovation and great practice across NHS organisations in order to improve the consistency of patient care.

Publishing articles to explain improvement projects is a great way to support the spread and adoption of new knowledge and best practices.

The West of England Academy has teamed up with BMJ Quality to provide additional support to staff members leading an improvement project, including the ability to document the progress of the project with a view to publishing when it is completed.

For more information or if you would like a licence, please contact:


The Health Foundation has produced useful resources to help with communication approaches and on writing for publication:

< Step 5: Implement, embed and sustain

< The Improvement Journey