Fig. 2

IHI Framework for Spread. IHI’s earlier Framework for Spread [28] identifies six areas that have been shown to contribute to successful spread: the role of organizational or governmental leadership in setting the agenda for change, aligning incentives, and establishing accountability; the development of better ideas and practices that demonstrate the relative advantage of such practices over the old way; the development and use of communications channels and messages; the strengthening the social system; the use of data to guide spread; and the refinement of the spread effort as needed, based on feedback from the field and data on the performance of the system