Diffusion of Innovation Theory was popularized through the work of Everett Rogers in his book, Diffusion of Innovations first published in 1962 (Nelson, 2002; Wikipedia, n.d.). Rogers postulates this theory to explain how new practices and ideas are adopted into more common use by describing groups as defined by their change-adoption behavior in response to the introduction of an innovation. These are:
- Innovators – comfortable with uncertainty, curious and demonstrating competencies in technical concepts, this 2.5% of the population are the first to adopt a change, however they are not likely to significantly influence others to adopt the change.
- Early Adopters – may be more discreet in their adoption of change, but this 13.5% also tend to be open to new ideas. They are more likely to be perceived as credible and therefore are able to persuade others to consider using an innovation.
- Early Majority – represent 34% of the population. They are comfortable with and open to change, but are not compelled to be first to a change or innovation.They are characterized by a willingness to adapt.
- Late Majority – are the next 34% to adopt an innovation. They need more compelling evidence and momentum to adopt a change.
- Laggards – are the final group, who tend to adopt an innovation only when there is no other alternative. They represent 16% of the population and they are characterized by suspicion of change, innovation and change agents (Nelson, 2002; Rosemann, 2015).
I find “the chasm” – first introduced by Moore in his 1991 book, Crossing the Chasm – to be of significant interest (Wikipedia, n.d.). Let’s look at the example of the history of hand-washing as an infection prevention and control technique to consider the implications of the chasm. I feel like every health care professional has heard the story of Ignas Semmelweis, the house officer of two obstetrics clinics in the 1800’s who postulated that physicians and their students who moved directly from autopsies to the delivery suite were introducing “cadaverous particles” to their maternity patients. Semmelweis theorized it was these particles resulting in increased mortality in the wards tended by physicians, as compared to the wards tended by midwives (WHO, 2009). Semmelweis introduced a change in practice whereby physicians washed their hands in a chlorinated lime solution before interacting with maternity patients. The mortality rate dropped from 16% to 13%, a clinically significant reduction. Despite this compelling clinical evidence, the change did not stick…Semmelwies encountered “the chasm”, where this innovation died. The innovation of hand-washing experienced more starts and stops in the experiences of Oliver Wendel Holmes and Florence Nightingale, each time, falling into “the chasm”, thus preventing the widespread adoption of the innovation (Global Handwashing Partnership, n.d.; WHO, 2009).
This is where the fields of implementation science, quality improvement, change management and others come into play (Mrklas, 2020). Regardless of whether a change is a “good” change or not, resistance, poor timing, insufficient marketing, and many other factors, can block the momentum of that change and result in a lack of diffusion. Practice areas like those listed above can help to carry an idea forward by creating compelling individual and organizational connections to the evidence, rationale and potential benefit of the change. With hand-washing, it took national campaign by the US Centers for Disease Control and Prevention after multiple outbreaks of foodborne and healthcare-associated infections to bring hand-washing over the chasm thus creating diffusion to the early majority and late majority (Global Handwashing Partnership, n.d.; WHO, 2009). I would like to say that hand-washing has even been adopted by the laggards, however we have all heard depressing statistics of hand-washing audits within healthcare, so best to say our work is not yet done here.
The compelling question arising from this theory for me is “why?” Why did “baby Yoda” go viral? Why do we still engage in healthcare practices with clear evidence to the contrary? And why did it take so long to ban trans-fats? It seems to me that in asking why, we get to how, and that is truly motivating. There is so much to learn about how to diffuse and operationalize healthcare improvements.
References
Wikipedia: Crossing the Chasm. (n.d.). Retrieved from https://en.wikipedia.org/wiki /Crossing_the_Chasm
History, Global Handwashing Partnership. (n.d.). Retrieved from https://globalhandwashing.org/about-handwashing/history-of-handwashing/
Mathers, B. (n.d.) Diffusion of Innovation. Retrieved from https://bryanmmathers.com/diffusion-of-innovation-2/
Mrklas, K. (2020, January). Demystifying Implementation – How can implementation science help us manage quality? Webinar, AHS Provincial Quality Management Team: Community Seniors Addiction and Mental Health, Calgary, AB.
Nelson, R. (2002). Major theories supporting health care informatics. In Health care informatics: An interdisciplinary approach. St Louis, MO: Elsevier.
Roseman, M. (QUT IFB 101). (2015, Feb). Diffusion of Innovation, Queensland University of Technology [Video File]. Retrieved from https://www.youtube.com/watch?v=kxVeLlTEgtU
WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization. (2009). 4, Historical perspective on hand hygiene in health care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK144018/