Helen Bevan on the best practice puzzle

The role of the NHS Institute for Innovation and Improvement is to generate high-impact solutions to some of the biggest challenges facing NHS organisations. But simply generating them is not enough. We are only effective if our solutions are widely disseminated and adopted.

This happens all too rarely, a phenomenon change experts call 'the best practice puzzle'.

Quality-management consultant Paul Plsek, one of the world's greatest healthcare improvement thinkers, has been acting as a 'critical friend' to the institute on its dissemination plans. Four pieces of wise advice from Plsek, developed here, are as applicable to local commissioners and providers as they are to us.

• Avoid declaring victory too soon. Encouraging results from pilot projects are a great start but they are only the start. I have been to hospitals, for instance, that insist they have implemented the Modernisation Agency's 10 high-impact changes. On closer inspection, the principles have been adopted for only a minority of patients, missing the opportunity for a big impact on the whole system.
• Do not assume the rationale that encouraged pilot sites to take part will work with the majority of sites. Most are risk-averse and will not be early adopters of ideas. Identify the needs of target sites - what it will take to convince them to change - and build that in from the start of the pilot project. Data from pilots must be capable both of assuring the innovators on the pilot project that they have succeeded and convincing other sites to come on board.
• Plan to reach the 'tipping point' to spread new practice widely. The principle is that when a new idea is adopted by around 15-20 per cent of the target, it is likely to take on a life of its own and spread naturally. If it does not reach that tipping point, it is unlikely to go further, no matter how much effort and inspiration has gone into it. So, in designing its dissemination strategy, the institute needs to target at least 15-20 per cent of the total audience, whether this is primary care trust leaders adopting our care outside hospital programme or nurse leaders with Productive Ward. What would be your equivalent 15-20 per cent?
• Generate a 'social buzz' to spread the new idea beyond the tipping point. If 20 per cent of the practices within your PCT adopt the new way of working but the other 80 per cent do not know about it, dissemination will not happen. Change leaders need to tap into natural channels and networks of communication. Who talks to whom; how do people hear about what is happening in other places? Work both with the formal systems, such as professional associations, and informal systems, such as situations where people we want to influence get together.

Helen Bevan is director of service transformation at the NHS Institute for Innovation and Improvement.