The pursuit of new and innovative technologies, therapies and products in health and healthcare is generally seen as a necessity for ensuring the sustainability of our health systems. However, the diffusion and large-scale adoption of promising healthcare innovations can be troublesome at times. History teaches us that innovations with proven effectiveness are sometimes completely ignored by the healthcare sector, while innovations of arguable quality sometimes enjoy a large uptake. We will illustrate this by two examples of effective innovations that were not properly adopted, followed by two examples of widely implemented but highly inefficient innovations.

Promising innovations that were (or still are) not properly adopted:

  • Vitamin C usage to prevent scurvy (effective): Even though it was proven in the year 1747 that citrus fruits (vitamin c) were effective for treating and preventing scurvy, it was not until 1795 that the British navy started distributing citrus fruits amongst its sailors to prevent the disease. The British Board of Trade only followed in 1865.  
  • Doctors frequently washing their hands in hospitals (effective): While it is common knowledge that proper hygiene is an effective way of preventing infections, it is estimated that 15 – 30 % of infections in hospitals still are considered preventable. In 2001, researchers found that there are approximately 5000 deaths in the United Kingdom annually due to a lack of hygiene in hospitals.

 

Ineffective innovations that were adopted on a large scale:

  • Restraining elderly patients to prevent falls (ineffective): For many decades, it has been common practice in hospitals and nursing homes to restrain patients who are at risk of falling and injuring themselves. Currently, the academic literature suggests that using physical restraints generally does more harm than good to a patient, as it often leads to soft tissue injuries, fractures, delirium and in some cases even death. However, involuntary immobilisation still seems to be applied on a large scale. 
  • Pre-operative shaving (ineffective): Preoperative hair removal is commonly performed to reduce the chance of surgical site infection. The academic literature does not support this notion however, and there are even indications that pre-operative shaving could increase the chances of infection due to damaging of the skin.

 

Everett Rogers’ model

Everett Rogers (1931–2004) developed an interesting theory on the diffusion of innovations. Diffusion is defined by Rogers as the process by which an innovation is communicated through certain channels over time among the members of a particular social system. Rogers acknowledges that spreading a new idea is both a spontaneous, passive process as well as an active, planned process (explicit efforts to persuade target groups to adopt an innovation).

With his theory, Rogers tries to illustrate why some innovations are adopted, while other innovations are rejected. The figure below summarises the various processes and features which can contribute to an individual’s decision of either adopting or rejecting an innovation.

Figure: Simplistic visualisation of the four main elements in the diffusion of innovations (Rogers, 2003)
Elements of diffusion of innovations

In the figure you can see that an innovation (1) is communicated through certain channels (2) over time (3) among the members of a social system (4). In the following subsections we will briefly explain each of the four elements and what they encompass.

Explaining the four elements of diffusion

1. Innovation

An innovation is described by Rogers as an idea, practice or object that is perceived as new by an individual or other unit of adoption. The following attributes, as perceived by individuals, contribute to the eventual adoption or rejection of innovations:

  1. Relative advantage: The degree to which an innovation is perceived as being better than the idea it supersedes. An innovation with a clear added value in the eyes of potential end users is more easily and rapidly adopted. 
  2. Compatibility: The extent to which an innovation is seen as consistent with someone’s existing values, norms, needs and past experiences.
  3. Complexity: The degree to which an innovation is perceived as difficult to understand and use. Easily comprehended innovations generally diffuse more quickly within a social system than complex and sophisticated innovations.
  4. Trialability: The extent to which an innovation can be experimented with before making a definitive adoption decision. An innovation with which one can experiment freely to some extent, is more easily and rapidly adopted. 
  5. Observability: The degree to which the outcomes of using an innovation are visible to others. Clearly visible beneficial outcomes from using an innovation facilitate and expedite the diffusion process.
  6. Reinvention: The extent to which individuals can customise and modify an innovation to optimise its usage. An innovation diffuses more rapidly and structurally when it can be re-invented.

 

2. Communication channel

A communication channel is the means by which information is conveyed between individuals. Mass media channels (e.g. television, radio, newspapers) are generally a fast and effective way of creating awareness of an innovation amongst a large audience. Interpersonal channels (e.g. a face-to-face exchange between individuals) on the other hand, are often more effective in persuading an individual to form a favourable opinion on an innovation. The social aspect and peer influence play an important role in the diffusion of innovations. The more homophilous the people in a social system are, the greater the chance an innovation will diffuse within that social system once one person adopts it.

3. Time

When looking at the element of time, we can distinguish 5 steps in the innovation-decision process, which usually occur in the following chronological order:

  1. Knowledge: Awareness of an innovation’s existence is obtained, as well as some understanding on what the innovation does and how it works.
  2. Persuasion: An individual forms either a favourable or unfavourable attitude towards the innovation.
  3. Decision: A choice is made by an individual (either consciously or unconsciously) to adopt or reject the innovation.
  4. Implementation: The individual starts using the innovation. This is also the stage where reinvention of the innovation is likely to occur.
  5. Confirmation: An individual evaluates his or her previous innovation-decision (the decision to either adopt or reject). This previous decision may be reversed if the individual experiences cues that conflict with his/her innovation-decision.

 

The time-dimension can also be applied when looking at various “adopter categories.” We can distinguish between (1) innovators, (2) early adopters, (3) early majority, (4) late majority and (5) laggards. Most innovations have an S-shaped rate of adoption when looking at the time dimension in the figure below:
Adoption curve

4. Social system

The social system determines the boundaries of diffusion. Opinion leaders are an internal part of the social system, and have the ability to influence other individuals’ attitudes or overt behaviour in a desired way with relative frequency. Change agents operate externally from the social system, and try to influence clients’ innovation-decisions in a direction deemed desirable by a change agency.

Depending on the influences from within the social system, we can distinguish between 3 types of innovation-decisions:

  1. Optional innovation-decisions: The choice to adopt or reject an innovation is made by an individual and is independent of the decisions of other members of the social system.
  2. Collective innovation-decisions: The choice to adopt or reject an innovation is made by consensus among the members of a social system.
  3. Authority innovation-decisions: The choice to adopt or reject an innovation is made by relatively few individuals in a social system who possess power, status or technical expertise.

 

References (and highly recommended read)

Rogers, E.M. 2003. Diffusion of Innovations (5th edition). Free Press: New York.