Executive Summary


Veronica F. Nieva, PhD 
Shannon Fair, RN, MPH 
Laura Gray, MPH 
Julie Bergmann, MHS


  • For an innovation to spread, it is critical to define its core elements, which have to be preserved in all efforts to implement the innovation in other settings, while recognizing the importance of adapting and tailoring other elements to the requirements of each implementation setting. Distinguishing between core and adaptable elements is not a simple task.
  • Innovations need to be “packaged” for spread. Their benefits must be clearly and strongly stated in terms that are relevant to each stakeholder audience. Because innovations are often complex, packaging must include an array of implementation aids: training, operational manuals, organization charts, process flows, and the like. Few innovations have the necessary implementation packages.
  • In many cases, innovators have no interest, or skill, in spreading their innovations. Thus, for spread to occur, innovators must be connected with spread agents, which can take a variety of forms.
  • Many stakeholders have to be activated and aligned in order for innovations to spread effectively. A robust multistakeholder infrastructure will be needed to speed up the spread of cardiovascular and other innovations throughout the health care sector. For spread efforts to succeed, innovators must engage multiple stakeholders, including hospital/health system leadership, providers, patients and families, communities, employers, public entities, private funders, connectors, adopter organizations, and spread organizations. The benefits to these stakeholders need to be articulated in a compelling and targeted way.
  • Potential adopter organizations must provide fertile ground for the innovation. A culture that is generally open to change is critical, but any specific change must align with the organization’s current priorities. Organizational change champions are critical to overcome the inevitable barriers that face any effort to do things in a different way.
  • Many implementation tactics, at macro and micro levels of organization, must be explored. Some of these tactics have a broad focus, such as organizational partnerships and collaboration by entities that have not traditionally worked together, and the use of media to create awareness and demand for innovative approaches to care delivery. Other tactical considerations are more targeted to individual adopter organizations; these include approaching innovation efforts incrementally versus aiming for more comprehensive programs at the outset, adopting a narrower stand-alone program, and exploring integrated solutions.
  • Efforts to spread improvements in cardiovascular health and other innovations may be assisted by transformations that are underway in the health care environment. These include payment systems that are moving from volume-based schemas to ones that emphasize value and outcomes, changing roles and scope of the health care workforce, and development of new provider and delivery systems. The potential for an important role of traditional and new media in promoting the spread of these innovations has yet to be exploited. Scaling and spreading innovations will be facilitated by exploring their possible integration into larger experimental models (e.g., Patient-Centered Medical Homes and Accountable Care Organizations), which will likely become part of the health care landscape in the near future.

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