Readiness for spread, dissemination, scaling up

Spread, scaling up, dissemination, diffusion - whatever you want to calls it - does NOT happen in healthcare in the automatic "tipping point" way of Gladwell.  This is largely because in healthcare, the NHS being one great example, the desire to spread is a top-down prescriptive one - which is most companies would be dealt with a a large scale implementation project.  Similarly, just focusing on how to describe and communicate  the innovation is not enough. (I've written about this in previous posts.)

Whatever you call it and whatever methods you use, there is evidence that there are some key factors which need to be in place before you set off on a large scale "thingy".  These are not clever, and, in fact, are annoyingly obvious. Obvious does not mean simple.  You already know about the list below and one major step forward in your large scale work is to examine why you're not working on these "readiness" factors.

1. Strategic focus: if the imitative is not named and talked about in the organisation (and team) level as a strategic piece of work to do, then it's probably not a large scale change or one which will be given priority
2. Executive sponsor: who in the organisation is responsible and accountable for the implementation (not the planning) of the change?
3. Day-to-day leadership: is the initiative being talked about?
4. Spread aim: is there a clear aim and method of measuring progress for spread / scaling up?
5. Spread / scaling up Plan: is there one? Is there one that scales down each level of implementation?
6. Costs: are the costs of the change clear? DO they include the staff time coasts? Is there an agreed ROI for the scale up?
7. How will fidelity be ensured? (Fidelity = what is scaled up / spread is the same as the initiator project)

Some references:

(There are many references available in peer-reviewed papers, however, as many of you have complained you don't have access to these, I have listed some more general and open access references. If you know of other easy access references then please comment on this blog.)

• IHI: A framework for spread
• Agency for Healthcare Research & Quality: Innovation readiness for spread
• Some of my books: Rolling out your project includes a whole section on diagnosing readiness for change. 

More on the fallacy of the tipping point

Last time I wrote about the fallacy of the tipping point I received a host of comments asking me to defend my thoughts a bit more. I ended up in a number of email conversations, some of which have persisted over the last few months.

The debate is essentially a Gladwell (as "son-of-Rogers") versus Watts debate if you want the protagonists' version. I see it more about Taylorist approach versus the networked world. Gladwell, like Rogers, has pursued very eloquently the theory that messages spread through a hierarchical type of system. It is based on a number of key influencers who spread the word. This is what he calls the "Law of the Few" which posits there are a few specifically influential people who spread the word. While there is some social system consideration in this approach it is essentially, to me, one of control and organisations. Maybe this is why so many leaders and organisations have fallen in love with the theory of the tipping point - it gives them a handle on which to explain their process driven communication plans.

I have felt for a long time that Gladwell/Rogers is way out of date when it comes to communication. Much of the arguments Gladwell use come from the 1990's - and can you remember how you used to communicate on both a small and large scale back then? Much of Roger's research was done pre-internet.

So, on the other hand, we have Duncan Watts who is approaching the debate from a networking perspective. His work demonstrates we are as likely to get information form a fairly random contact as we are from a "key influencer". The Watts approach to creating a viral experience for a message is harnessing the power of ordinary people's networks and strategies. Sure, there may be some influentials who spread the word, however, what Watts is making us think about is this may not be the only reason message spread. Gladwell's theories and examples are presented as a hub and spoke model - whereas Watts uses a more networked model which to me seems to more accurately reflect my world and experience. The difficulty of course is that it is not as easy to design a message spreading program is we believe the spread is more random than controlled.

One example both have used is the famous 6 degrees of separation one. Each has taken his own perspective. Gladwell repeats Milgram's results. Watts tested the theory using email and found that only 5% of the messages spread through what might be called Influentials - the rest was down to ordinary and perhaps less connected people.

If I had to invest in a spread strategy I would be looking to create learning communities, to be harnessing existing online connections, finding ways to get the messages into the email systems, developing content that worked on an online format etc. I used to be sold on the Rogers then Gladwell format but my own action research has led me to lean more to Watts.