A qualitative Grounded Theory approach was used. Four home care organizations in Ontario that had implemented best practice guidelines related to older adults (i.e., falls prevention, pain management, management of venous leg ulcers) participated in the study. Qualitative interviews were conducted with 8-12 front line providers, managers and directors per site at baseline (n=44) and one year later (n=40). Participants discussed their involvement in the process of spread, perceived facilitators and barriers to spread and outcomes related to spread. Open, axial and selective coding and constant comparison analysis were used to develop a theory of the process of spread.