The Science of Spread: How Innovations in Care Become the Norm

Thomas Bodenheimer, MD

Why do some useful innovations take hold quickly while others never seem to catch on? This report summarizes the emerging science of "spread" and provides case studies of health care organizations successfully promoting institutional change.

September 2007

The publication of Malcolm Gladwell's Tipping Point popularized the insight that some new ideas, behaviors, and technologies quickly gain traction in the world, while others never move beyond a small group of early adopters. The power of the "tipping point" phenomenon is perhaps most commonly invoked in the marketing of consumer products or the analysis of fads and trends.

But what about health improvement work, an arena far removed from that of plasma-screen televisions and iPods?

This report explains why the spread of improvements in health care organizations is distinctly different from the diffusion of innovative ideas in other areas of life. It summarizes some of the thinking within the emerging science of "spread" and provides case studies of health care organizations that have achieved some degree of success in the broad diffusion of institutional change.

The author concludes that while the concept that improvement will spread by itself once a tipping point has been reached is often not true for health care organizations, such real-world examples and a growing body of scientific literature provide both a cause for optimism and some useful lessons.

The complete report is available under Document Downloads.