Disseminating from the Centre to the Frontline: The Diffusion and Local Ownership of a National Health Policy Through the Use of Icons

  • David GreenfieldEmail author
  • Margaret Banks
  • Anne Hogden
  • Jeffrey Braithwaite
Part of the Organizational Behaviour in Health Care book series (OBHC)


Regulatory bodies continually confront the issue of how to diffuse health policies effectively, particularly those directed at changing frontline clinical practice. Knowing how to disseminate, embed and sustain improvements is a universal challenge. Being able to achieve ownership of policy at a local level, while ensuring a consistent national message, is a further complicating dimension. In this study we sought to answer the question: how can the Australian Commission on Safety and Quality in Health Care (ACSQHC) know the extent to which the National Safety and Quality Health Service (NSQHS) Standards information is disseminated to frontline clinicians? To do so, we conducted a unique study examining the diffusion of the NSQHS Standards, represented visually by icons, across the healthcare system. Using document analysis of two administrative databases, the study identified that by mid-2015 over 440 applications to use the icons had been received from healthcare organisations. Icons are being used for educational and clinical awareness raising purposes in diverse settings within organisations, across all states and territories. The representation of policy in the form of icons has allowed for ease of distribution, uptake, presentation, and recognition. The icons are an effective strategy for both the widespread diffusion and local ownership of a national health policy to those at the frontline of healthcare delivery.


Dissemination Diffusion Icons Policy 


  1. ACSQHC. (2013). Accreditation and the NSQHS Standards. Retrieved from Accessed 14 March 2016.
  2. Australian National Audit Office. (2006). Implementation of programme and policy initiatives: Making implementaiton matter. Canberra: Commonwealth of Austalia.Google Scholar
  3. Braithwaite, J., Greenfield, D., & Westbrook, M. T. (2010). Converging and diverging concepts in culture and climate research: Cultate or climure? In J. Braithwaite, P. Hyde, & C. Pope (Eds.), Culture and climate in health care organisations (pp. 7–18). Basingstoke: Palgrave-Macmillian.CrossRefGoogle Scholar
  4. Braithwaite, J., Westbrook, J., Johnston, B., Clark, S., Brandon, M., Banks, M., et al. (2011). Strengthening organizational performance through accreditation research: The ACCREDIT project. BMC Research Notes, 4, 390.CrossRefGoogle Scholar
  5. Brusamento, S., Legido-Quigley, H., Panteli, D., Turk, E., Knai, C., Saliba, V., et al. (2012). Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU Member States: A systematic review. Health Policy, 107(2–3), 168–183.CrossRefGoogle Scholar
  6. Bywood, P., Lunnay, B., & Roche, A. (2008). Effective dissemination: A systematic review of implementation strategies for the AOD field. Adelaide: National Centre for Education and Training on Addiction.Google Scholar
  7. Clavier, C., Gendron, S., Lamontagne, L., & Potvin, L. (2012). Understanding similarities in the local implementation of a healthy environment programme: Insights from policy studies. Social Science and Medicine, 75(1), 171–178.CrossRefGoogle Scholar
  8. Daniel, M., Kamani, T., El-Shunnar, S., Jaberoo, M.-C., Harrison, A., Yalamanchili, S., et al. (2013). National Institute for Clinical Excellence guidelines on the surgical management of otitis media with effusion: Are they being followed and have they changed practice? International Journal of Pediatric Otorhinolaryngology, 77(1), 54–58.CrossRefGoogle Scholar
  9. Dunlop, C. A., & Radaelli, C. M. (2013). Systematising policy learning: From monolith to dimensions. Political Studies, 61(3), 599–619.CrossRefGoogle Scholar
  10. Giguère, A., Légaré, F., Grimshaw, J., Turcotte, S., Fiander, M., Grudniewicz, A., et al. (2012). Printed educational materials: Effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 10. Retrieved from Accessed 14 March 2016.
  11. Greenfield, D. (2010). Accountability and transparency through the technologisation of practice. In J. Braithwaite, P. Hyd, & C. Pope (Eds.), Culture and climate in health care organisations (pp. 185–195). London: Palgrave Macmillan.CrossRefGoogle Scholar
  12. Greenfield, D., & Braithwaite, J. (2008). Health sector accreditation research: A systematic review. International Journal for Quality in Health Care, 20(3), 172–183.CrossRefGoogle Scholar
  13. Greenfield, D., Pawsey, M., & Braithwaite, J. (2012a). The role and impact of accreditation on the healthcare revolution (O papel e o impacto da acreditação na revolução da atenção à saúde). Acreditação, 1(2), 1–14.Google Scholar
  14. Greenfield, D., Pawsey, M., Hinchcliff, R., Moldovan, M., & Braithwaite, J. (2012b). The standard of healthcare accreditation standards: A review of empirical research underpinning their development and impact. BMC Health Service Research, 12, 329.CrossRefGoogle Scholar
  15. Greenfield, D., Pawsey, M., & Braithwaite, J. (2013). Accreditation: A global regulatory mechanism to promote quality and safety. In W. Sollecito & J. Johnson (Eds.), Continuous quality improvement in health care (4th ed., pp. 513–531). New York: Jones and Barlett Learning.Google Scholar
  16. Grimshaw, J., Thomas, R., MacLennan, G., Fraser, C., Ramsay, C., Vale, L., et al. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment, 8(6), 1–84.CrossRefGoogle Scholar
  17. Hinchcliff, R., Greenfield, D., Moldovan, M., Pawsey, M., Mumford, V., Westbrook, J., et al. (2012). Narrative synthesis of health service accreditation literature. BMJ Quality and Safety, 21, 979–991.CrossRefGoogle Scholar
  18. Kapsali, M. (2011). How to implement innovation policies through projects successfully. Technovation, 31(12), 615–626.CrossRefGoogle Scholar
  19. Khayatzadeh-Mahani, A., Nekoei-Moghadam, M., Esfandiari, A., Ramezani, F., & Parva, S. (2013). Clinical governance implementation: A developing country perspective. Clinical Governance, 18(3), 186–199.CrossRefGoogle Scholar
  20. Kilewo, E. G. (2015). Factors that hinder community participation in developing and implementing comprehensive council health plans in Manyoni District. Tanzania. Global Health Action, 8(1), 26461.CrossRefGoogle Scholar
  21. Lauvergeon, S., Burnand, B., & Peytremann-Bridevaux, I. (2012). Chronic disease management: A qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders. BMC Health Service Research, 12(1), 1.CrossRefGoogle Scholar
  22. Lustria, M. L. A., Noar, S. M., Cortese, J., Van Stee, S. K., Glueckauf, R. L., & Lee, J. (2013). A meta-analysis of web-delivered tailored health behavior change interventions. Journal of Health Communication, 18(9), 1039–1069.CrossRefGoogle Scholar
  23. National Health and Medical Research Council. (2000). How to put evidence into practice: Implementation and dissemination strategies. Canberra: NHMRC.Google Scholar
  24. Park, C., Wilding, M., & Chung, C. (2014). The importance of feedback: Policy transfer, translation and the role of communication. Policy Studies, 35(4), 397–412.CrossRefGoogle Scholar
  25. Prior, L., Wilson, J., Donnelly, M., Murphy, A. W., Smith, S. M., Byrne, M., et al. (2014). Translating policy into practice: A case study in the secondary prevention of coronary heart disease. Health Expectations, 17(2), 291–301.CrossRefGoogle Scholar
  26. Rideout, L. (2016). Nurses’ perceptions of barriers and facilitators affecting the Shaken Baby Syndrome Education Initiative: An exploratory study of a Massachusetts public policy. Journal of Trauma Nursing, 23(3), 125–137.CrossRefGoogle Scholar
  27. Rubenstein, L., Khodyakov, D., Hempel, S., Danz, M., Salem-Schatz, S., Foy, R., et al. (2014). How can we recognize continuous quality improvement? International Journal for Quality in Health Care, 26(1), 6–15.CrossRefGoogle Scholar
  28. Seddon, D., Krayer, A., Robinson, C., Woods, B., & Tommis, Y. (2013). Care coordination: Translating policy into practice for older people. Quality in Ageing and Older Adults, 14(2), 81–92.CrossRefGoogle Scholar
  29. Shayo, E., Vaga, B., Moland, K. M., Kamuzora, P., & Blystad, A. (2014). Challenges of disseminating clinical practice guidelines in a weak health system: The case of HIV and infant feeding recommendations in Tanzania. International Breastfeeding Journal, 9, 188.CrossRefGoogle Scholar
  30. Stone, D. (2012). Transfer and translation of policy. Policy Studies, 33(6), 483–499.CrossRefGoogle Scholar
  31. Truran, P., Critchley, R. J., & Gilliam, A. (2011). Does using the WHO surgical checklist improve compliance to venous thromboembolism prophylaxis guidelines? Surgery, 9(6), 309–311.Google Scholar
  32. Weber, E. J., Mason, S., Carter, A., & Hew, R. L. (2011). Emptying the corridors of shame: Organizational lessons from England’s 4-hour emergency throughput target. Annals of Emergency Medicine, 57(2), 79–88.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • David Greenfield
    • 1
    Email author
  • Margaret Banks
    • 2
  • Anne Hogden
    • 3
  • Jeffrey Braithwaite
    • 3
  1. 1.Australian Institute of Health Service ManagementUniversity of TasmaniaNSWAustralia
  2. 2.Australian Commission on Safety and Quality in Health CareSydneyAustralia
  3. 3.Australian Institute of Health InnovationMacquarie UniversityNSWAustralia

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