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PubMed1998

Marketing innovations to nurses, Part 2: Marketing's role in the adoption of innovations.

This article is the second in a two-part series concerning marketing techniques to enhance nurses' adoption of innovations. Introducing and getting staff to implement new policies and procedures constitute an important part of the WOC nurse's role. The application of Rogers' Diffusion of innovation Theory provides WOC nurses with a framework to introduce innovations into the clinical setting and to change subsequent practice patterns. This article introduces the WOC nurse to marketing principles needed to successfully introduce a practice innovation to nurse colleagues; it also builds upon Rogers' Diffusion of Innovation Theory and presents a sample marketing plan as a template for marketing innovations in the clinical setting.

Critical Care↗
PubMed2001

Innovation in nursing homes: which facilities are the early adopters?

PURPOSE: This study examined organizational and market factors associated with nursing homes that are most likely to be early adopters of innovations. Early adopter institutions, defined as the first 20% of facilities to adopt an innovation, are important because they subsequently facilitate the diffusion of innovations to others in the industry. DESIGN AND METHODS: Two groups of innovations were examined, special care units and subacute care services. I used discrete-time logistic regression analysis and nationally representative data from 13,162 facilities at risk of being early adopters of innovations during twelve 6-month intervals from 1992 to 1997. RESULTS: Organizational factors that increase the likelihood of early innovation adoption are larger bed size, chain membership, and high levels of private-pay residents. Four market factors that increase the likelihood of early innovation adoption are: a retrospective Medicaid reimbursement methodology, a more competitive environment, higher average income in the county, and a higher number of hospital beds in the county. IMPLICATIONS: This analysis shows that organizational and market characteristics of nursing homes affect their propensity toward early adoption of innovations. Some of the results may be useful for nursing home administrators and policy makers attempting to promote innovation.

Aged↗
PubMed2004

Texas physicians' perceptions of genomic medicine as an innovation.

Primary care providers (PCPs) are believed to be the professionals who, in the near future, will be responsible for incorporating genomic medicine (GM) into primary care. Given the dearth of empirical data describing PCPs' beliefs about GM and the relationship between beliefs and the incorporation of GM into practice, this study assessed whether (and to what extent) PCPs' perceptions of GM as an innovation influence their likelihood of adopting this innovation into primary care. The study utilized diffusion of innovations theory as a framework. A state-wide representative sample of PCPs practicing in Texas responded to a mailed survey. The survey measured PCPs' perceptions of five characteristics of GM as an innovation. Findings suggest that among the five characteristics examined GM's relative advantage, compatibility with current practice, its complexity, and observability were the strongest predictors of likelihood to adopt GM tasks into primary care practice.

Adult↗
PubMed2004

Improving the state of health programming by using diffusion theory.

Year by year, the gaps between what is known about behavior change and what is actually practiced in social programs grow larger, especially for community-based programs intended to help minority populations, the poor, and those living in inner-city and rural areas. Internationally, such gaps between the state of knowledge and the state of practice lead to disparities in health, education, and development among societal groups, demographic sub-populations, communities, and countries. Data about disparities are used as evidence of inequality. Here, I discuss uses of certain diffusion of innovation theory-based concepts to systematically redress problems of inequality and disparity by reducing the differences between evidence and practice in social programs that are implemented by intermediaries (practitioners) and communicated by them to needy populations. The emphasis here is on the integrated application of knowledge about innovation attributes, opinion leadership, and clustering from diffusion theory to achieve the objective of more extensive and more rapid diffusion of especially effective programs. A set of implementation steps are offered for researchers, funders of international health programs, and the intermediaries who implement health programs.

Communication↗
PubMedDate not supplied

Early adoption of BRCA1/2 testing: who and why.

PURPOSE: Relatively little is known about the characteristics of women who chose to undergo BRCA1/2 testing soon after testing became available, including how they became aware of and chose to pursue testing. Diffusion of innovation theory states that acceptance of an innovation is a function of the potential adopter's value for innovation and perceptions of the compatibility, complexity, and relative advantage of the innovation. These factors may contribute to early uptake of BRCA1/2 testing. The purpose of this study was to describe the characteristics of women who were "early adopters" of clinical BRCA1/2 testing and to determine whether diffusion theory explains variation in uptake of testing after participation in genetic counseling for BRCA1/2 testing. METHODS: A retrospective cohort study of participants in genetic counseling for BRCA1/2 testing was conducted at a clinical program in a large academic health system. Measures included components of diffusion of innovation theory (participant's value for innovation, i.e., "innovativeness," and perceptions of the compatibility, complexity, and relative advantage of BRCA1/2 testing), characteristics of how the participant became aware of and sought BRCA1/2 testing, and decisions about testing after counseling. RESULTS: From the 229 respondents, 71 (31%) had undergone testing at the time of the survey. Fifty-seven women (25%) had sought BRCA1/2 testing because a family member had breast or ovarian cancer and 37 (16%) because they had breast or ovarian cancer. Only 15 women (7%) reported seeking testing because of a physician's recommendation. After multivariate adjustment, higher innovativeness and higher ratings of the compatibility of BRCA1/2 testing were associated with undergoing testing after counseling [relative risk (RR) 1.76, 95% confidence interval (CI) 1.2-2.6]. However, ratings of the complexity or relative advantage of testing were not associated with testing decisions. Higher innovativeness was associated with being the first in the family to undergo testing (RR 4.85, 95% CI 1.6-14.9), becoming aware of BRCA1/2 testing through the media (RR 1.50, 95% CI 1.0-2.4), and being aware of BRCA1/2 testing prior to counseling (RR 1.25, 95% CI 1.1-1.4). CONCLUSIONS: The uptake of BRCA1/2 testing among women undergoing genetic counseling was associated with innovative characteristics of the participant and the perceived compatibility of the test with existing values and needs, but not with the complexity or relative advantage of the test. Most "early adopters" had heard of BRCA1/2 testing from a source other than their physician and had sought testing because of a personal or family member's cancer diagnosis. These findings can inform predictions surrounding the introduction of future genetic susceptibility tests and strategies for guiding the further diffusion of BRCA1/2 testing.

Decision Making↗
PubMed2002

A framework for the dissemination and utilization of research for health-care policy and practice.

PURPOSE: The purpose of this paper is to construct a comprehensive framework of research dissemination and utilization that is useful for both health policy and clinical decision-making. ORGANIZING CONSTRUCT: The framework illustrates that the process of the adoption of research evidence into health-care decision-making is influenced by a variety of characteristics related to the individual, organization, environment and innovation. The framework also demonstrates the complex inter-relationships among these characteristics as progression through the five stages of innovation namely, knowledge, persuasion, decision, implementation and confirmation occurs. Finally, the framework integrates the concepts of research dissemination, evidence-based decision-making and research utilization within the diffusion of innovations theory. METHODS: During the discussion of each stage of the innovation adoption process, relevant literature from the management field (i.e., diffusion of innovations, organizational management and decision-making) and health-care sector (i.e., research dissemination and utilization and evidence-based practice) is summarized. Studies providing empirical data contributing to the development of the framework were assessed for methodological quality. CONCLUSIONS: The process of research dissemination and utilization is complex and determined by numerous intervening variables related to the innovation (research evidence), organization, environment and individual.

Clinical Nursing Research↗
PubMed2000

Evaluation of a data warehouse in an academic health sciences center.

OBJECTIVES: The Clinical data repository (CDR) at the University of Virginia Health System is a data warehouse that provides direct access to data for clinical research and effective decision making. We undertook an evaluation of the CDR to understand factors affecting its adoption. DESIGN: We used a theoretical framework that is based on diffusion of innovation theory. Building on validated survey instruments, we developed a questionnaire and conducted interviews of key executive leaders. Fifty-three individuals with logon ids to the CDR completed our questionnaire. Twelve executive leaders were interviewed. MEASUREMENTS: The outcome variables were the initial and continued use of the CDR. Independent variables included attributes suggested by diffusion theory (i.e. relative advantage, complexity), knowledge and skills expected to correlate with computer usage, and the influence of communication channels. RESULTS: Our overall response rate was 82%. We identified characteristics of users associated with the initial decision to use the CDR. Compatibility with an individual's skills and work style was associated strongly with satisfaction and continued use. Secondly, the importance of organizational culture and the need for data was illuminated by management interviews. CONCLUSIONS: We have shown that diffusion of innovation theory can be used to help understand factors contributing to the success of a data warehouse in a healthcare setting. Our results suggest areas for future research and inquiry as the CDR evolves.

Academic Medical Centers↗
PubMed2006

A convergent diffusion and social marketing approach for disseminating proven approaches to physical activity promotion.

Approaches from diffusion of innovations and social marketing are used here to propose efficient means to promote and enhance the dissemination of evidence-based physical activity programs. While both approaches have traditionally been conceptualized as top-down, center-to-periphery, centralized efforts at social change, their operational methods have usually differed. The operational methods of diffusion theory have a strong relational emphasis, while the operational methods of social marketing have a strong transactional emphasis. Here, we argue for a convergence of diffusion of innovation and social marketing principles to stimulate the efficient dissemination of proven-effective programs. In general terms, we are encouraging a focus on societal sectors as a logical and efficient means for enhancing the impact of dissemination efforts. This requires an understanding of complex organizations and the functional roles played by different individuals in such organizations. In specific terms, ten principles are provided for working effectively within societal sectors and enhancing user involvement in the processes of adoption and implementation.

Cooperative Behavior↗
PubMed2006

Categorizing the unintended sociotechnical consequences of computerized provider order entry.

OBJECTIVE: To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting. DESIGN: Ethnographic and interview data were collected by an interdisciplinary team over a 7 month period at four clinics. MEASUREMENTS: Instances of unintended consequences were categorized using an expanded Diffusion of Innovations theory framework. RESULTS: The framework was clarified and expanded. There are both desirable and undesirable unintended consequences, and they can be either direct or indirect, but there are also many consequences that are not clearly either desirable or undesirable or may even be both, depending on one's perspective. The undesirable consequences include error and security concerns and issues related to alerts, workflow, ergonomics, interpersonal relations, and reimplementations. CONCLUSION: Consequences of implementing and reimplementing clinical systems are complex. The expanded Diffusion of Innovations theory framework is a useful tool for analyzing such consequences.

Ambulatory Care↗
PubMed2006

From a genetic innovation to mass health programmes: the diffusion of Down's Syndrome prenatal screening and diagnostic techniques in France.

Down's Syndrome prenatal diagnostic and screening techniques have spread widely in France over the last 30 years and are now part of the routine clinical practice of prenatal care. These techniques, which originated in the field of genetics, ultrasonography and biochemistry, were the first to provide the possibility of choosing the features of the foetus, or at least to reject some of its characteristics. They lead to new norms of healthy foetuses and a progressive acceptance of medical abortions. The aim of this paper is to understand how the use of these tests has been generalised in France despite scientific controversies about their risks and ethical questioning about a potential renewal of eugenics. It analyses the representations of public needs that have been articulated by key players in the scientific and medical fields. This research explores political and administrative decision making processes to understand how progressively widening public access to prenatal testing has been organised and funded. The results highlight the scientific and political role of biomedical researchers, the forms of involvement of health authorities and politicians, and the passive participation of the vast majority of the users. The paper also examines the characteristics of the French health system that facilitated the generalised use of the technology.

Abortion, Eugenic↗
PubMed1994

Putting prevention into practice.

In primary medical care settings, disease prevention services are delivered at lower rates than recommended. Furthermore, practitioners tend to overestimate the rate at which they perform them. There are essentially two steps in delivering evidence-based preventive services: (1) knowing what the evidence is for performing various detection and intervention manoeuvres, and (2) integrating the preventive services into daily practice. The first is a scientific process and is carried out in Canada by the Canadian Task Force on the Periodic Health Examination. However, after a decade of experience with evidence-based guidelines, we now know that guidelines are not enough. Integrating clinical prevention into busy practices is a political and logistical process. This truth is best captured by the quip, "An ounce of prevention requires a pound of office system change". A number of studies have demonstrated that continuing medical education (CME) courses and workshops for physicians are not enough to ensure that clinical preventive services are incorporated into practice. According to Lomas, the traditional CME educational approaches need to be complemented by strategies from such paradigms as the social influence model, the diffusion of innovation model and the adult learning model. Battista, in "From Science to Practice," points out the complexity of the communication process required for the diffusion of innovation into practice. Walsh's Systems Model of Clinical Preventive care best captures the interacting factors that mediate between practitioners' intentions and their actions when it comes to delivering clinical prevention services. This paper reports on a practical example of helping family practitioners develop a "sustaining office system in prevention" that minimizes barriers, focuses energy and integrates clinical prevention into office routines. The key components are (i) a practice coordinator for prevention, (ii) clear clinical prevention-related job descriptions for all persons who deal with patients, (iii) an information management system that reinforces prevention, and (iv) a practice feedback and problem solving strategy.

Aged↗
PubMed1988

The partialization strategy: an empirical reformulation of demonstration project planning.

The demonstration project approach to planning is described and analyzed. Reasons for its frequent failure as a chosen strategy are delineated. The article introduces the concept of partialization as a broader framework for understanding and using demonstration projects. Four key elements for implementing the partialization strategy through selecting an appropriate initial demonstration site are delineated: success potential, access, linkage, and acceptance by the larger population. Partialization in this context examined two research case studies. The case studies provide specific illustrations of how partialization, when conducted as postulated, facilitated desired diffusion of innovations.

California↗
PubMed1999

George Rupert Palmer--DRG carrier and champion.

Prompted by the retirement of the distinguished health economist, researcher and academic, Professor George Rupert Palmer, the purpose of this paper is to reflect upon and acknowledge one of his many contributions to health services research and development. By employing a conceptual framework devised by Kimberly and de Pouvourville (1993) for analysis of the diffusion of innovations, this paper argues that Palmer played a crucial role in the diffusion into and within Australia of a particular casemix method, diagnosis related groups (DRGs). Textual and interview evidence presented in the paper supports the identification of George Rupert Palmer as the principal carrier of DRGs into Australia, and as one of its key champions within Australia.

Australia↗
PubMedDate not supplied

Social marketing and diffusion-based strategies for communicating with unique populations: HIV prevention in San Francisco.

We conducted a 2-year investigation of the extent to which strategies based on social marketing and diffusion of innovations concepts are used in preventive health communication with unique (highly ostracized) populations. Of the 49 organizations in San Francisco that operate HIV prevention programs (N = 100), programs that most highly targeted unique populations were surveyed. Personal interviews were then conducted with 38 staff leaders who operated the most and least effective programs. Audiotapes and transcripts were content analyzed to identify the strategies used by program staff. Strategies based on social marketing concepts were more prevalent than strategies based on the diffusion of innovations: More effective programs were characterized by emphasis on homophily, audience segmentation, compatibility-based strategies, and interorganizational collaboration.

Adult↗
PubMedDate not supplied

New and dis-improved: on the evaluation and use of less effective, less expensive medical interventions.

The innovation and diffusion of new technologies is in large measure responsible for the persistent rise in the cost of health care. The increasing cost of health care, in turn, will make cost-saving technologies more attractive. When cost-saving technologies lead to better or equivalent outcomes, their acceptance will not be controversial. However, the necessary conditions for the development and clinical acceptance of cost-saving technologies that might diminish the quality of health care have not been systematically considered. Indeed, as the clinical research enterprise has been focused almost entirely on quality-improving (or quality-neutral) innovations, new concepts may need to be introduced for quality-reducing innovations. Although the development of such therapies would, at least in some circumstances, increase overall societal benefits, replacing a standard therapy with a less effective one may conflict with deeply held values, such that conventional cost-effectiveness benchmarks might not apply. In addition, from a clinical research perspective, there are considerable ethical and methodologic hurdles that might impede the development of less expensive, less intensive therapies. In this article, using a hypothetical scenario, the authors consider economic, ethical, and research design issues concerning the innovation and diffusion of less effective, less expensive therapies and introduce 2 concepts--"decremental cost-effectiveness" and "acceptability trials"--that may in part provide a research framework for the study of "new and dis-improved" therapies.

Clinical Trials as Topic↗
PubMed1993

Managerial style and health promotion programs.

Organizational correlates of worksite health promotion programs were isolated and interpreted within a diffusion of innovation framework. A sample of managers from California (U.S.A.) 500 organizations were interviewed via telephone on their corporate management styles and health care strategies. Organizational management style was found to be related to prevalence of health promotion programs and future plans for health promotion programs. Specifically, this study found that organizations with democratic management styles are more likely to plan, adopt, and/or implement worksite health promotion programs when compared to organizations with authoritarian management styles. An additional contribution of this study was the development and validation of the Organizational Management Style (OMS) scale. These results have important theoretical and practical implications. For example, these findings explain why some organizations are more or less likely to adopt health promotion programs. Both diffusion of innovation and social control explanations are used to interpret the results.

California↗