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Module 6: Sustaining and Spreading Changes in Practice

Learning objectives


Action steps and tools

Learning objectives

  • Coach sites to support sustainability and spread from the beginning of a program
  • Prepare sites to continually improve even after your coaching time with them is over
  • Coach organizations to spread to new locations: standardize core elements while allowing room for customization



The Safety Net Medical Home Initiative Framework for Practice Transformation that serves as the basis for Coach Medical Home is a capacity-building approach. The Framework emphasizes leadership and quality improvement as the bases for any improvement effort, including PCMH transformation. A transformation effort built around the Change Concepts will be in good shape for sustainability and spread.

The facilitator’s guide and tools below aim to help you coach a practice to sustain and spread PCMH transformation periods even when the coaching period is over. In addition, the facilitator’s guide includes a case study from Group Health Cooperative.

Action steps and tools

Action step Tool

Plan for sustainability

Health Quality Ontario Sustainability Planner
Includes tips for engaging leaders, creating standard work, and building in commitment to ongoing measurement.

Beginning with the End in Mind
PowerPoint Presentation from the Institute for Healthcare Improvement outlining how a practice transformation effort should design implementation to support spread within the organization.

Spread and Sustainability handout adapted from NHS Guide
One page checklist created by Qualis Health based on the UK's National Health Service Modernization Agency (NHS) improvement leader’s guide.

Plan for spread

Supporting Spread – Lessons learned from the California Improvement Network
Summary of Lessons Learned on spread from this consortium of California organizations.

Health Quality Ontario Spread Planner
Includes tips for selecting what to spread, and the mechanisms and resources to do so.


Additional references

Hsu C et al. 2012. Spreading a patient-centered medical home redesign: a case study. J Ambul Care Manage 35(2):99-108.

Cohen DJ et al. 2008. Fidelity versus flexibility: translating evidence-based research into practice. Am J Prev Med 35(5 Suppl):S381-9.