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Theory of diffusion of innovation in nursing

Health services administration Abstract Maximising the adoption of evidence-based practice has been argued to be a major factor in determining healthcare outcomes.

However, there are gaps between evidence-based recommendations and current care. Bridging the evidence gap will not be achieved simply by informing clinicians about the evidence. He argues that certain characteristics of the innovation itself may facilitate its adoption.

Diffusion of Innovation Theory

Other factors infuencing acceptance include promotion by influential role models, the degree of complexity of the change, compatibility with existing values and needs, and the ability to test and modify the new procedure before adopting it. The diffusion model may provide valuable insights into why some practices change and others do not, as well as guiding those who try to effect adoption of best-evidence practice. The adoption of a new clinical behaviour by a clinician and healthcare system is a consequence of multiple factors, with research evidence being only one.

Research on the diffusion or adoption of innovations suggests that a number of themes come into play. This theoretical framework is helpful when determining the adoption of specific clinical behaviours and when deciding which components will require additional effort if diffusion is to occur. It includes a consideration of aspects of the innovation or new technologystyle of communication, steps in decision making, and the social context.

The innovation According to Rogers 2 there are five elements of a new or substitute clinical behaviour that will each partly determine whether adoption or diffusion of a new activity will occur: Research provides information on the cost-effectiveness and potential benefit to patients of implementing a new clinical activity. Decisions about implementing best-evidence practice are driven not only by patient welfare but also by the interplay between the interests of the patient, the clinician and the healthcare system.

Conversely, if the recommended behaviour increases the status of adopting clinicians and brings in more revenue for individuals or the organisation, the innovation may be readily adopted. To increase the theory of diffusion of innovation in nursing of adoption, the innovation must address an issue that clinicians or others perceive to be a problem. For example, a new procedure that enables early detection of a life-threatening illness is likely to be adopted.

Early screening tests are compatible with medical beliefs that early detection of disease is beneficial.

Diffusion of innovation theory for clinical change

Consequently, tests and procedures that appear to offer this capacity are more likely to be adopted. Real-life examples include the rapid adoption of mammography screening 34 and testing for prostate cancer, 5 despite some debate about their effectiveness.

A clinical procedure is more likely to be adopted if it is simple and well defined. In contrast, preventive activities such as detecting and treating patients with hazardous alcohol consumption 6 and smoking 7 have not been adopted quickly, in spite of the potential health gain. This may, at least in part, be a result of the complexity of these activities.

  • Geriatr Nurs 2000; 21;
  • The controversy of prostate screening.

Moreover, some clinicians may have insufficient expertise in the consulting skills necessary to achieve change. The ability to test a potential medical intervention on a limited basis allows clinicians to explore the implementation of the procedure, its acceptability to patients, and the potential outcomes. Rogers argues that the facility to undertake a limited cost—benefit trial of an intervention promotes faith that the evidence is correct and that its implementation is logistically possible.

If respected and influential clinicians argue for and demonstrate the application of a new procedure or treatment approach, it is likely to have a positive impact upon adoption rates.

Current research suggests that the most effective communication strategy is face-to-face exchange. Interpersonal communication is usually more effective when there is a high degree of professional resemblance between the individual attempting to introduce the innovation and the recipient.

This may partly explain why clinical audits undertaken by medical practitioners are more likely to lead to adoption of a new practice than those performed by allied health staff. Individuals and organisations will move through the decision process at different rates, depending upon whether they are innovators, or early or late adopters.

Innovators are characterised by their tolerance of high levels of uncertainty. The social context The systems most likely to respond easily and quickly to innovation are ones that have a culture of creativity and innovation, a relatively flat hierarchical system, and strong leadership that is committed to effecting change.

In contrast, the healthcare system has a hierarchical model, with separate organisational structures for each professional group.

Behavioral Change Models

The system is often bureaucratic, with social norms that hinder rapid change. However, within this system, it is possible for clinicians to change some aspects of their clinical activities relatively rapidly, as there are few restraints on determining the choice of care.

Changing to evidence-based clinical behaviour may mean modifying the system so that it adequately monitors the frequency of the activity, the outcomes, feedback to the clinician and contingencies for desired clinical behaviour.

Summary Diffusion theory offers a plausible explanation for why some clinical activities are adopted rapidly and others only with difficulty, despite strong evidence of their potential benefits. Some clinical behaviours may be adopted relatively easily because of the nature of the behaviour itself, while others may involve a complex interplay between social systems, communication style and the decision-making process.

There is a need to prospectively test the assumptions of the model in the healthcare environment using rigorous experimental design. Physician and practice characteristics associated with the early utilization of new prescription drugs. Med Care 2003; 41: Ann Intern Med 2002; 13: Ann Intern Med 2003; 138: The controversy of prostate screening. Geriatr Nurs 2000; 21: Addressing alcohol use among primary care patients: J Gen Intern Med 1994; 9: Screening for adolescent smoking among primary care physicians in California.

Am J Public Health 1997; 87: Closing the gap between research and practice: Explaining diffusion patterns for complex health care innovations. Health Care Manage Rev 2002; 27: Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.

  • Conclusion The Diffusion of Innovation theory is a very important theory that can serve administrators, information technologists, nursing informatics experts, and change agents well;
  • Screening for adolescent smoking among primary care physicians in California.