Scale-Up and Spread

As more of our teams use QI and see improvement in outcomes, the question of ‘spread’ is coming up frequently. It is difficult to spread successful improvement initiatives and maintain the effect size in other settings. Without careful thought and planning, the gains made in the test ward/team will not be replicated.

What do we mean by ‘sustainability’ and ‘spread’?

Sustainability scale up spread

Below is a checklist to see if you’re ready to think about scale up or spread:

Spread checklist

 If you can answer Yes to all 5 questions, then your project may be ready to considered for spread:

1. Fill our the ELFT QI Scale up & Spread Planner and send in to the QI team, who will get in touch and help you with your spread plan. The spread project will be registered as a new project, and will need its own measurement plan, project lead and sponsor.

2. If the spread site is within your local directorate, present the spread plan at your QI forum. It will need DMT sign-off before proceeding

3. If the spread site is across directorates, it will need executive approval through the monthly QI project strategy group (the QI team will support you with this)


You might want to have a read of the Seven Spreadly Sins to help you think about what not to do!


Supporting Scale up and Spread

 ELFT QI Spread Checklist  ELFT Spread Planner  Seven spreadly sins  A frame work for spread
ELFT Scale Up and Spread Checklist – Are you ready to spread? ELFT Spread Planner  Seven Spreadly Sins (Infographic: Kaiser Permanente Labor
Management Partnership, 2015)
IHI – A Framework for Spread – From Local Improvements to System-Wide Change


 Spread planner Ontario  Using communications approaches to spread improvement  QI Hub - spread and sustainability  Using a Framework for spread
Ontario Spread Planner Using communications approaches to spread improvement – A practical guide to help you effectively communicate and spread your improvement work. The Health Foundation The Spread and Sustainability of QI in Healthcare – Quality Improvement Hub Using a Framework for Spread – The Case of Patient Access in the Veterans Health Administration (Journal on Quality and Patient Safety)



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