Skip to content


Developing a Spread Toolkit

Developing a Spread Toolkit to support sustainability and spread

Read comments 16
  • Proposal
  • 2020

Meet the team


  • Nicola Lowe, Quality Improvement Engagement Lead

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

Covid has unleashed innovation and positive change from the NHS workforce.  Staff have been empowered to challenge norms, and deliver services differently.  At Somerset NHS FT alone, over 200 staff led innovations have been implemented and sustained (as featured in this IHM report:

This project is inspired by the Billions Institute ( and the IHI Psychology of Change Framework paper ( During Covid, we have needed to rethink how we do spread and sustainability, and created a toolkit that builds on our learning from the Billions Institute and the extraordinary circumstances we have found ourselves in. The approach has been co-created and well received amongst our immediate teams.  This process and funding would allow us to take it to the next stage. Incorporating knowledge from other recommended sources including the Health Foundation ‘The Spread Challenge’ & ‘Creating Contagious Commitment to Change’ by Andrea Shapiro.

Our project driver diagram is here:

What does your project aim to achieve?

This project aims to deliver a spread toolkit that has been co-created, and tested with 6 teams by 01/08/2022. We want to equip improvers with the tools they need to ensure that changes, including those from Covid, are sustained and spread. Beneficiaries are improvement teams, wider NHS staff members and importantly patients. The toolkit will be accessible to everyone electronically bringing tools, guides and links to support spread together. The refined toolkit will be applicable to all healthcare settings, contributing to spreading change to everyone, reducing health inequalities.

Outcome measure: A completed spread toolkit (guide and set of tools) that has been proven to work

Process Measures: No. of people involved in co-creation: by discipline, QI expert, non-QI expert, patients, other Trusts, &, no. of tests undertaken by each group

Balancing Measure: Participants feedback on co-creation & testing processes, &, user feedback on ease of use of toolkit and outcomes achieved by using it

How will the project be delivered?

The initial design of the toolkit has already begun in Somerset, led by a Senior Improvement Advisor working in collaboration with other advisors and our Engagement Lead. Input from benefits, project management and process design analysts are being sought so that it is robust. If successful in this bid we would aspire to co-create the toolkit with a multidisciplinary national team and set up a patient group to gain their perspective & input.

We have approached the South West AHSN who work closely with the Billions Institute, to gain their support. We hop this bid will help build a community of people who wish to be involved. Working with participants virtually using MS Teams we wish to refine the toolkit through user testing, meeting virtually monthly to share progress and learning.

Following testing learning will be consolidated with the MDT national team in order to produce the final toolkit online.

How is your project going to share learning?

We are committed to sharing our learning. To spread and share the toolkit we have created internal & external communications campaigns using spread methodology.

To build awareness, as well as this bid, we have a slot in the Academy of Fabulous Stuff Global Virtual Conference 20/10/2020. We intend to participate in other improvement related events through our Improvement Evidence Lead e.g. IHI & Q conferences. We will share bi-monthly project updates and learning though our Q exchange project page.

To build will we are inviting people to create and test the toolkit with us, undertaking their own PDSA cycles, learning and then sharing with the group. We have requested a Q community special interest group for asynchronous discussion about the toolkit to enable all Q members to participate and learn together.

Through the Q community we would like to facilitate extension agents and use fishbowls to help spread more widely.

How you can contribute

  • Critical friends - to provide challenge on the idea to help improve it & highlight what is good and what might need further work
  • Experts - to share their expertise based on their professional background or personal experience with spreading change
  • Promoters - to share the idea and learning with others within Q, their own organisation and beyond
  • Collaborators - to help co-create the toolkit and to help test the toolkit
  • Networks - to make introductions that might be helpful to progress this idea within or outside the Q Community

Plan timeline

30 Mar 2020 Start of research & compiling of ideas for toolkit
14 Apr 2020 Start of development of macro toolkit with Improvement Advisors
15 Jun 2020 Completed draft Macro Toolkit-Stage 1-Dig Deep-What & Why?
13 Jul 2020 Completed draft Macro Toolkit-Stage 2-Dream Big-How much by when?
14 Sep 2020 Completed draft Macro Toolkit-Stage 3- Add zeros-How?
22 Sep 2020 Submit project idea for Q bid & support on expanding idea
30 Sep 2020 Engagement with Project Managers, Benefits & Process Design Analysts in co-creation
18 Dec 2020 Completed draft Macro Toolkit-Stage 4-No Heroes-Letting Go!
1 Feb 2021 Special Interest Group set up by this date
8 Mar 2021 Clinical leads join co-creation group
1 Apr 2021 Create MDT to co-create toolkit including patient input
10 Apr 2021 Set up fortnightly meetings (MS Teams)-Use Skills map from Q-Improvement-Lab
1 Aug 2021 Launch co-created toolkit, ready to test
10 Aug 2021 Set up monthly debriefs on MS Teams to share learning
15 Nov 2021 Review & celebrate event (half way through testing)
1 Apr 2022 Complete testing of toolkit
1 Aug 2022 Consolidated learning & launch of refined editable spread toolkit


  1. Hi Marie. It's been great chatting with you about this project idea and sharing the learning from our @Evidence4QI Q Exchange Project.  Its also wonderful to see that you've made contact with the South West Academic Science Network.  As discussed, as part of the early stages of the project it would be great to do a literature review of all of the different approaches to spread to ensure that the project incorporates and builds on best practice from other industries / organisations beyond healthcare.  Myself and the @Evidence4QI team would be delighted to help you with this.  Good luck!

    1. Hi Andrea, thank you for your support with this, it is very much appreciated. I look forward to see the outcome of the literature review and am excited to learn more.

  2. Marie,

    This is a great idea and I do hope that you take it forward. If you need any process visualizations done then please let me know as I'd love to help. Good luck with your idea.


    1. Hi Tom, that would be fantastic and something that I had not really thought about. Thank you so much for your support. Process visualizations could really help to share knowledge and create awareness.

  3. Hi Marie,

    Myself and my colleague Emma Adams (Health Transformation Partnership) are supporting the Health Foundation this year by fostering conversations between Q members and encouraging collaboration.

    My apologies that I've come to reviewing your idea quite late in the process. I see Louise has already highlighted the publications I was going to mention. However, in addition to this, several Q members (pre COVID) visited GSK to learn about their approach: 'Creating Contagious Commitment to Change'.  The underpinning philosophy and methods are described in the book 'Creating Contagious Commitment' by Andrea Shapiro Ph. D. It's all about the factors which interact when you're trying to spread an approach: Contact between Advocates & Apathetics, Mass Exposure, Hire Advocates, Shift Resisters, Infrastructure, Walk the Talk, Reward & Recognition. If it's of interest, I can connect you to an ex GSK employee who specialises in this area. Either way, I wish you the best of luck with your idea (great video, by the way!!).


    1. Hi Pete, I would really appreciate being connected to an ex GSK employee who specialises in spread. My e-mail address is I have just ordered the book 'Creating Contagious Commitment' and am looking forward to reading it. Thank you so much for these connections.

  4. I am really excited about the prospect of testing the spread toolkit with real projects and with people all across the QI community. This is such important work because it will demystify the recipe for spread and enable people to apply sound theory to practice using simple tools. The result will be many more people spreading their great work to all the people who can benefit.

    1. Hi Sarah, I am really excited as well. In the design of the toolkit we need to consider the size of spread: micro, meso, exo or macro system, making it simple to understand and allowing people to pick the tools they need in order to spread the great work they have done.

  5. Hi Marie,

    If you're not already aware of this, there are a couple of Health Foundation reports that may be of interest in helping to shape your project:

    Using communications approaches to spread improvement

    The Spread Challenge

    Good luck with your bid!


    1. Hi Louise,

      I have read The Spread Challenge which has helped to cement some of what I have already learnt but has also challenged me to think a lot more about the adopter role.

      As part of the steps, for macro spread that I have started to put together, there is some stakeholder analysis around the roles in Everett Rogers Adoption Curve & how we engage with them. I have now realised that this needs to be done much earlier on so that they can be part of the co design when we look at what we are going to spread & how it needs to adapted into the area we are spreading.

      My aim in co-creation of the spread toolkit is to really simplify the spread process, as much as possible, building on peoples experience and knowledge and then testing & refining the toolkit seeing what results it can produce. It would be great if you would like to to help with the co-creation?

    2. Hi Louise, thank you so much for your support and suggestions. I have read a number of reports but have not come across these which provide really useful information.

  6. Hi Marie. This sounds a fab idea. I'd certainly be interested in being a 'guinea-pig' for any user-testing outside of your locality.

    1. Hi Gareth, that will be amazing. I am making a list of people interested in this as I would like to gain as much input as possible.

  7. Thank you Andrea. That is a brilliant idea.

  8. This is a really great idea.  So many changes we, as an improvement community support are not sustained. It's one of those wicked problems. Can I suggest that you make contact with Sarah Robens at SWAHSN as I know that she has a wealth of experience in this space that you could tap into to develop this bid.

    1. Hi Andrea, just to let you now that I have successfully contacted Stuart Monk at SWAHSN. I am really excited about talking through the project with him. Thank you for your advice.

Leave a comment

If you have a Q account please log in before posting your comment.

Read our comments policy before posting your comment.

This will not be publicly visible

Please note that you won't be able to edit or delete comments once posted.