Using a framework for spread: The case of patient access in the Veterans Health Administration

Jt Comm J Qual Patient Saf. 2005 Jun;31(6):339-47. doi: 10.1016/s1553-7250(05)31045-2.


Background: Experience indicates that an effective operational system will spread much more slowly than, for example, a new antinausea drug. The Veterans Health Administration (VHA) used a Framework for Spread to spread improvements in access to more than 1800 outpatient clinics between April 2001 and December 2003. The framework identifies strategies and methods for planning and guiding the spread of new ideas or new operational systems, including the responsibilities of leadership, packaging the new ideas, communication, strengthening the social system, measurement and feedback, and knowledge management. APPLYING THE FRAMEWORK FOR SPREAD: Following a collaborative for reducing waiting times for patients without the large-scale addition of resources, each of the participating 22 Veterans Integrated Service Networks (VISNs) used the framework to expand improvements in access to care to six additional targeted clinics (for example, primary care, eye care, cardiology).

Results: During the VHAs spread initiative, waiting time for a primary care appointment decreased from 60.4 days at the end of fiscal year (FY) 2000 to 28.4 at the end of FY 2002. Results were sustained. Waiting time was <25 days at the end of FY 2004.

Discussion: The Framework for Spread suggests areas that organizations should consider when developing and executing a strategy for a spread initiative. Further study is needed to determine the specific activities that should be emphasized to accelerate spread.

MeSH terms

  • Appointments and Schedules
  • Communication
  • Delivery of Health Care, Integrated / organization & administration
  • Efficiency, Organizational
  • Health Services Accessibility / organization & administration*
  • Health Services Needs and Demand / organization & administration
  • Humans
  • Leadership
  • Management Information Systems
  • Organizational Innovation*
  • Primary Health Care / organization & administration
  • Quality Assurance, Health Care / organization & administration
  • Total Quality Management / organization & administration*
  • United States
  • United States Department of Veterans Affairs / organization & administration*