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Maximizing the Benefit of Quality Improvement Activities

A Spread of Innovations Model

Wolak, Erica MHA, RN, NE-BC; Overman, Angela MSN, RN, NE-BC; Willis, Beth MHA, LSS, MBB; Hedges, Christine PhD, RN, NE-BC; Spivak, Glen F. MBA

doi: 10.1097/NCQ.0000000000000438
Original Article: PDF Only

Background: Many organizations struggle to efficiently and effectively spread improvement activities. This article presents findings from a model developed to standardize the sharing of innovative ideas within nursing at an academic medical center.

Problem: Quality improvement activities were occurring in many nursing units but often did not spread beyond the originating unit. Challenges included variability in operationalizing initiatives, inconsistent understanding of project goals, and the lack of a dissemination process.

Approach: The Spread of Innovations Model was developed to ensure structure and resources are in place to spread successful initiatives. The model uses Lean problem-solving and engages frontline nurses with senior leadership when spreading internally developed best practices.

Outcomes: The model was piloted by spreading a catheter-associated urinary tract infection (CAUTI) prevention project throughout nursing. Using the model led to significantly decreased CAUTIs.

Conclusions: Improvement efforts without a process for spreading can lead to inefficiencies and variable outcomes.

Nursing Quality and Research (Ms Wolak and Dr Hedges) and Inpatient Surgery (Ms Overman), University of North Carolina Hospitals, Chapel Hill; and Operational Efficiency (Ms Willis) and Carolina Value and Operational Efficiency (Mr Spivak), University of North Carolina Health Care, Chapel Hill.

Correspondence: Erica Wolak, MHA, RN, NE-BC, University of North Carolina Hospitals, 101 Manning Dr, Chapel Hill, NC 27514 (

The authors thank the following individuals from the University of North Carolina Hospitals (UNCH) for their significant support of the Spread of Innovations Model: Dr Catherine Madigan (Senior Vice President and Chief Nursing Officer for UNCH), Jacqueline Harden Jacobs (Vice President and Associate Chief Nursing Officer for UNCH), Dr Mary Tonges (retired Chief Nursing Officer, UNCH), Dr Emily Sickbert-Bennett (Director, UNCH Epidemiology), Lisa Teal (Associate Director, UNCH Epidemiology), Agnes Royal (Nurse Manager), and Beth Huenniger (Clinical Nurse IV).

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: July 26, 2019

Published ahead of print: August 26, 2019

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