| Course | NU708 Advanced Systems Leadership: Transforming the Health Care Organization |
|---|---|
| Unit | Unit 8 |
| Paper type | Spread plan |
| Length | About 1,200 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU708 Unit 8
Four West First, Step-Down Last: A Unit 8 Spread Plan Carrying an Insulin Discharge Bundle to Eight More Units
[Student Name]
Purdue University Global
NU708: Advanced Systems Leadership: Transforming the Health Care Organization
Unit 8 Spread Plan
[Instructor Name]
[Date]
The hospital, its units, results and timeline are composite and illustrative; the frameworks and studies cited are real.
What Is Being Spread
The bundle has five components: the patient injecting once, with the pen that will go home, while a nurse watches; a written plan in everyday words; dispensing of that pen on the first insulin day; a contact by phone or visit within three days and a booked seat in the hospital's outpatient diabetes course, with a bridge supply for patients who have no other source. During the six-month pilot, 9 of 104 patients on new insulin returned within 30 days for a glucose problem, against 31 of 214 the year before. Patients with diabetes are readmitted more often than hospitalized patients in general (Rubin, 2015), so even a modest effect across the hospital would matter. The numbers are small and the pilot had an engaged lead, so the spread plan treats the result as promising, not proven, and keeps measuring.
The Framework
Massoud et al. (2006) describe a framework for spread with several elements: leadership that makes spread a priority and assigns responsibility, a better idea with evidence that it works, a set-up that defines the target population and the order of adoption, a social system through which the change travels, measurement and feedback and a way to manage the knowledge that adopters generate. Greenhalgh et al. (2004), reviewing hundreds of studies on the uptake of new practices by health services and other public organizations, add that adoption depends on attributes of the innovation as people perceive them: its relative advantage, compatibility with existing work, complexity, trialability and observability, along with the readiness of each receiving setting.
Leadership and Responsibility
The chief nursing officer has named the bundle a nursing priority for the year and approved the first phase of the business case. A nursing director is the spread owner, with a pharmacist and a hospitalist as co-leads. The DNP project lead coordinates the champion network and the measurement. Each unit manager is responsible for the bundle on that unit.
The Order of Units
The eight units differ in their volume of patients starting insulin and in their readiness. The order below puts the most ready units first, so that early success builds the case, and the hardest unit last, after the bundle has been refined.
1. 4 West, orthopedics and general surgery, months 1 to 3. About 55 patients a year start insulin, mostly for perioperative hyperglycemia. Stable staff and a manager experienced in tests of change.
2. 7 East, oncology, months 2 to 4. About 45 patients a year, many with steroid-induced hyperglycemia. Strong teaching culture.
3. 4 East, cardiac, months 4 to 6. About 70 patients, many with heart failure, which adds a reason for the hospital's quality office to care.
4. 5 East and 6 East, medical, months 5 to 8. The largest volume after the pilot units, about 110 patients a year combined.
5. 3 West, renal and medical, months 7 to 9. About 30 patients, with dosing complexity from kidney disease.
6. 2 North, women's and family, months 9 to 10. A small number of patients with gestational or pregestational diabetes, which needs adapted materials.
7. Step-down unit, months 10 to 12. About 40 patients, high acuity and high staff turnover.
The order is chosen so that the units most likely to succeed teach the units least likely to.
Fixed Core and Adaptable Parts
Greenhalgh et al. (2004) note that innovations that can be adapted to local settings spread more readily, but adaptation can strip out what made them work. The plan therefore names a fixed core: the supervised first injection using the pen the patient takes home, the filled prescription or bridge supply before the patient leaves and the 72-hour contact. These are the components most directly tied to the safety of the first days at home.
Units may adapt the rest. Oncology may time teaching around chemotherapy days. Orthopedics may teach before surgery for patients expected to need insulin. The women's unit will need materials for pregnancy, which the diabetes educator and an obstetric nurse will write. The cardiac unit may combine insulin teaching with its existing heart failure teaching session. Every adaptation is reported to the champion network, so that a good one can travel.
The Social System
Spread travels through people. Each unit has one or two champions, chosen by the manager and trained by the pilot champions in a two-hour session plus two observed demonstrations. Champions meet monthly. Each new unit is paired with an earlier one, 4 West with 5 West, 7 East with 6 West and so on, so that the receiving unit has a peer to call. The bundle's relative advantage is made observable at each unit huddle by a simple monthly chart of demonstrations completed and returns.
Measurement and Feedback
Four measures will be tracked monthly for each unit and reported to the bed meeting, the nursing quality council and the units themselves.
1. Adoption: the share of patients starting insulin who receive all three fixed-core components.
2. Fidelity: the share of return demonstrations done with the patient's own pen rather than a demonstration pen.
3. Outcome: the share of insulin starters back within a month with a high or low glucose, displayed on a run chart with the pilot baseline.
4. Balancing measure: median time from discharge order to departure for patients on new insulin, to detect whether the bundle delays discharges.
A unit is considered to have adopted the bundle when adoption is 80 percent or higher for three consecutive months. If a unit's adoption stays below 60 percent after three months, the spread owner and the champion network will review what is getting in the way before the next unit starts.
Knowledge Management
A shared folder will hold the current teaching materials, each unit's adaptations, the champion meeting notes and the monthly data. After each unit adopts, the champions will write a one-page note on what they changed and what they would tell the next unit. Those notes become the starting kit for the next unit.
Risks
The main risks are that the second educator position will not be approved in time, which would overload follow-up contacts by month six; that the electronic record build will be delayed, leaving adoption to be measured by hand; and that the step-down unit's turnover will erode training. The plan responds with trained follow-up nurses as a bridge, manual audits until the build is live and a refresher session every quarter on the step-down unit.
Conclusion
The plan carries a promising bundle to eight more units in a deliberate order, protects the components most tied to safety while letting units adapt the rest, uses paired units and champions as the channel for spread and measures adoption, fidelity, outcomes and delay so that the hospital will know whether the pilot's result holds across the organization.
References
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x
Massoud, M. R., Nielsen, G. A., Nolan, K., Schall, M. W., & Sevin, C. (2006). A framework for spread: From local improvements to system-wide change (IHI Innovation Series white paper). Institute for Healthcare Improvement.
Rubin, D. J. (2015). Hospital readmission of patients with diabetes. Current Diabetes Reports, 15(4), 17. https://doi.org/10.1007/s11892-015-0584-7
NU708 Unit 8 instructions, in plain terms
Unit 8 asks how a change that worked in one place will be carried across an organization. Prompts typically want the change and its evidence described, a spread framework applied, the target units or sites and their order, a decision about which components are fixed and which may be adapted, the people and channels that will carry the change, measures of adoption and outcome, and risks. Instructors look for a sequence with reasons, since spreading everywhere at once rarely works. The difference between the core of an intervention and its adaptable parts is often where the best plans distinguish themselves. A balancing measure, such as a delay the change might cause, shows awareness of trade-offs. Expect the plan to cite a spread or diffusion framework and to define in advance what counts as adoption.
Inside the NU708 Unit 8 example
The plan opens with the five components and the pilot result, with a caveat on its size and Rubin's review on why even a modest effect matters. The framework section introduces Massoud's elements and Greenhalgh's attributes of innovations. Leadership and responsibility are assigned to a nursing director with pharmacist and hospitalist co-leads. Eight units appear in a numbered order with months, volumes and reasons, under a highlighted line about strong units teaching weaker ones, with a margin note. The fixed core and adaptable parts follow, with examples for oncology, orthopedics, cardiac and women's units. Pairing and champions form the social system. Four measures and an adoption threshold are defined, flagged by a second note. Knowledge management, three risks with responses and a conclusion complete the plan.
NU708 Unit 8 rubric: what earns full points
Spread plans are scored heavily on the set-up: whether the order of units is reasoned and whether the target population is clear. Applying every element of a spread framework to the case, not merely naming it, adds points. Graders reward a clearly stated fixed core with a rationale, and adaptations that are specific to receiving units. The social system criterion looks for named roles and channels rather than general communication. Measurement is often decisive, and plans with adoption, fidelity, outcome and balancing measures, plus a threshold, score well. Risks need responses. Organization, a realistic timeline and APA 7 complete the rubric for NU708, and a plan that says what will happen if adoption stalls on a unit reads as more complete than one that assumes success.
Common NU708 Unit 8 mistakes, and how to avoid them
Spread plans lose marks most often by assuming the pilot will work unchanged everywhere. The opposite error, letting each unit adapt everything, also costs credit, since it can remove what made the change work. Some plans list units with no order or reason. Others track outcomes alone, which leaves the team unable to separate a unit that adopted the bundle from one that had a lucky quarter. Leaving out a balancing measure invites the objection that the change slows discharges. Plans that never say who carries the change between units also fall short. Start by writing the three components you would never let a unit drop, then rank the receiving units by readiness. A custom spread plan can be written for your own change and organization.
Get an NU708 Unit 8 example written to your instructions
Send the pilot, its results and the plan instructions with the rubric. A custom plan sets out what will spread, to which units, in what order and how it will be adapted. The first is free, delivered within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU708 Unit 8 questions, answered
What is the difference between scale-up and spread?
Spread usually means taking a change to similar units or sites; scale-up often means taking it to many sites or a whole system. Terms vary by source.
Should the plan change the intervention for new units?
Often, yes. The plan should say which core parts stay fixed and which can be adapted.
How is spread measured?
By how many units adopt the change, how faithfully and whether outcomes hold.
Where can I find a free NU708 Unit 8 sample paper?
The full NU708 Unit 8 spread plan is on this page. It carries an insulin discharge bundle to eight units in a reasoned order, with a fixed core, paired units, four measures and an adoption threshold.
What counts as adoption in the NU708 Unit 8 sample?
A unit has adopted the bundle when at least 80 percent of patients starting insulin receive all three fixed-core components for three consecutive months; below 60 percent after three months triggers a review.