Q: What is the need for spreading innovation in health care?

A: Spreading innovation is important, first of all, to make health care better, and second, to reduce costs. Organizations are investing in different departments or areas to improve them. They need to be able to get a return on that investment; they don't want to have to reinvent the wheel everywhere else. Although I do think that some reinvention has to go on, organizations need to reduce the human resource cost as well as the financial cost of ongoing improvement.

Q: What is the gap between current practice and best practice, in terms of spreading innovation?

A: I think we've barely even started. One of the difficulties is defining what "spread" is. Think of it as a continuum: at one extreme is "make it happen," where we make a deliberate decision to disseminate innovation. At the other extreme is "let it happen," which is about diffusion and the spontaneous adoption of change. Some of this spontaneous "let it happen" happens anyway, but in such a way that it's not always very helpful and doesn't happen at the right time. One of our challenges is to find a way that we can do as much of the "make it happen" type of spread work that feels positive, that people enjoy doing, and not just rely on the "let it happen" type of spread.

For example, say a new drug treatment comes out or we discover a new pathway for cancer treatment; we can try and disseminate that to a group of people. That may work in a small group of three or four organizations, but we may find there are another 150 organizations that could benefit if they copied the innovation. If we just "let it happen," it might take 20 years to make these changes. We need to do more of the "making it happen" instead, so that we improve health care in less than 20 years' time.

Q: You've done a lot of work with spreading innovation on the front lines. What are the barriers to spread? What are the issues that you see coming up again and again?

A: A lot of it is just general change management. One of the most common barriers is that people say a change will never work in their environment because it was specific to another hospital. In fact, they're correct: it doesn't work for them — because they need to go through their own reinvention process to make it their own. Another barrier is the lack of leadership: not actually involving the entire organization in the change process.

Q: What is the right kind of leadership for spreading innovation?

A: Leaders need to understand that every individual needs to go through some form of change process when they're adopting ideas from other people. This often requires leaders to stand back and not take credit for ideas or work that came from within their organization; in that sense, a certain amount of humility is required of leaders. Leaders also need to allow themselves and others to go looking for solutions to problems outside of the organization or in other areas of the organization. They need to be scanning the horizon, be out there looking very actively for promising innovations.

Q: Can you give me an example of "being out there looking"?

A: Many organizations have trouble with the number of hours that patients have to wait in the emergency department before they are seen. Some organizations try to solve the problem in-house. But one organization I know, with really good leadership, is always asking questions: "Who else is doing this really, really well? Let's go and visit them and find out how they are doing it." They routinely go out and learn from others and then come back and see what they can build into their own organization, rather than thinking they can do it all themselves.

Q: Can you give me an example of "reinventing" an innovation to make it your own?

A: Take an orthopedic surgical team in Hospital A and another orthopedic team in Hospital B. Although the hospitals may be almost identical — the same case mix, the same numbers of staff — there will be small differences between the two. The surgeons will have trained somewhat differently, maybe they have one more nurse at Hospital B, maybe the operating theatre is a slightly different shape. Those small differences can make a difference as to whether or not an innovation will work. So even though Hospital A runs its orthopedic operations really well, when you take that process to Hospital B, Hospital B has to go through a little reinvention process. In some places, that may be minor — just tailoring the process to fit them. Other places may actually have to do major reinvention; they might just have an organizational culture that says we have to reinvent a lot.

All the evidence says that reinvention is a necessary feature of change and adoption. We are interested in the extent to which it is necessary. When we talk about spreading innovation, we have to be careful about how we define the word "innovation." Although we recognize that people often need to reinvent locally, we don't want people to invent locally when in fact solutions are already out there that they can copy.

Q: What examples have you seen of "best practices" in spread?

A: One example of spread on a national scale is a program in the National Health Service (NHS) in the UK. Each year, the NHS chose 30 to 50 actual practitioner teams that were really good at what they were doing — whether it was mental health, or social services, or orthopedics, or cancer — and everybody within the National Health Service, 1.1 million employees, could, free of charge, go and visit one of these teams on one of their host days. It was very low profile, but it meant that, for example, nurses from one part of the country went to visit the cancer nurses at another place, or the orthopedic team at another, to find out what they were doing. It created a gentle network and gave people permission at very low cost to just get out there and learn.

Q: How can IHI's website help accelerate improvement in spread?

A: I see IHI's website as basically a virtual version of the NHS example I just described. People look at websites for content, particularly very practical content — tools and techniques that have worked well. They also want to connect with others in chat rooms. They're looking for a portal with lots of links and lots of ideas, connecting them to people and tapping into what others have learned. That's what they'll find here.