title: Systems and spread.
abstract: This is the fifth in a series of papers about the science of quality improvement. In this paper, we explore the issue of healthcare as a system and how this contributes to our understanding of how to spread improvement.
authors.affiliation: Primary and Prehospital Health Care, Community and Health Research Unit (CaHRU), University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK. nsiriwardena@lincoln.ac.uk.
authors.forename: A Niroshan
authors.initials: AN
authors.lastname: Siriwardena
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Gillam
mesh_terms: D004059:Diffusion of Innovation; D058006:General Practice / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000600:supply & distribution; D033181:Information Dissemination / Q000379:methods; D019982:Organizational Case Studies; D009936:Organizational Innovation; D010342:Patient Acceptance of Health Care; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000600:supply & distribution; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines