Large variation across health care organisations, teams and individuals is no longer acceptable. Initiatives in the UK National Health Service (NHS) to reduce variation and improve the delivery of services to patients and users include a number of wide ranging structural changes, such as the introduction of the Commission for Health Improvement, National Institute for Clinical Effectiveness, as well as clinical governance requirements in organisations. Other more interventional initiatives include nationally targeted improvement projects such as the Primary Care Collaborative, Cancer Collaborative, National Booked Admissions Programme, Coronary Heart Disease Programme and the Medicines Management Services Programme. In a process intended to reduce variation and make benefits widely available, the above NHS projects all include a phase where innovations and improvements developed in one primary care practice or hospital are rolled out to other similar teams and organisations. The intention of these programmes of change is to take these 'pilot' improved systems, and implement these in other organisations across the NHS. The spread and adoption of existing practices is a difficult and complex process. Much of the research on how this process works has focused on how one innovation has spread to many locations. Whilst there is some relevance from these studies for large scale spread programmes, they may not reflect the complexity of multiple innovations and their inter-relationships, or the local con- textual differences between individuals, teams and organisations. This guide provides a number of tools and resources for project managers and facilitators whose duties cover the rolling out of pilot projects to other teams and organisations. It does not attempt to provide a specific framework for a rollout project. Instead, the tools are designed to give the user sufficient insight so that they can develop a bespoke programme that specifically takes into account the characteristics of the subject matter and the local context.