How does Project ECHO work?

ECHO stands for Extension of Community Healthcare Outcomes. Here's how it works.

  • Spoke and hub members have initial meeting at which they establish a curriculum, times, dates, evaluation and responsibility for presenting teaching and cases at each meeting;
  • Commence knowledge network meetings, usually 75-120 minutes long;
  • 20-30 minutes teaching from topic expert. (Can be done from hub or spoke);
  • 2-3 case presentations based on template followed by network discussion;
  • Start and finish on time;
  • Facilitated by dedicated facilitator;
  • Supported by dedicated IT person and admin person;
  • All sessions filmed and along with additional materials forms a private online library that grows with the sessions.

What is the 'spoke' and what is the 'hub' in a knowledge network?

Project ECHO is about creating a supportive ‘knowledge network’. All members of the network are teachers and learners. Expertise lies both in the spokes and in the hub.


What differentiates the hub from the spoke is that the IT and administration support, and usually the facilitator of the network, are based at the hub. These crucial support roles enable the network to function smoothly and for participants to focus on the topics under discussion not the underlying technology or processes of Project ECHO.


A spoke is one of the connections of the network. Sometime spokes will include several individuals, for example the "Cedars care home" with five or six staff joining a care home knowledge network, the "Cedars spoke".

Sometimes spokes may just be a single individual, "John Smith", joining the network – the "John Smith spoke".

The terminology is used to help keep account of all who join and are participating in a network and to make it easier for the administration staff to ensure that all are signed up as network members.

Organisational Hub

In addition, and a source of occasional confusion, the term "Hub" is also used to describe an organisation which has undergone training, and signed off on a licence to run knowledge networks. Hospice UK is an example of a Hub in this sense, running a variety of knowledge networks.

What does hospice care mean to you?