One of the most profound and oldest theories in social science is the Diffusion of Innovation Theory. Conceptualized in 1962 by Everett Rogers, the theory is based on communication and seeks to offer an explanation on how a product of an idea diffuses and gains momentum over time through a particular social system or population. In this regard, diffusion can be described as the process through which the particular idea or innovations is communicated via particular channels over time and to the people that make up a social system (Rogers, 2003). Based on this definition, diffusion is a unique form of communication since the message in question pertains to new ideas. Further, the author reckons that communication is a process through which the people involved create and then share the information with one another in a bid to attain mutual understanding. Communication, therefore, is the process of either convergence or divergence as two or more people exchange information with the aim of moving apart or towards each other with respect to the meanings that they appropriate to specific events. Another important explanation is that diffusion is a form of social change and describes the process via which alteration takes place in the function and structure of a social system (Rogers, 2003). Following diffusion, the individuals that make up the social system adopt the new product, idea or behavior.
Adoption of Innovation
Adoption is vital in ensuring that a new product, idea or behavior creates impact. This implies that the targeted individuals end up doing something different compared to their previous practices. This may be achieved by purchasing and using a new product or acquiring and exhibiting a new behavior. For adoption to take place, the targeted individuals have to perceive the behavior, product or idea as innovative and new (Rogers, 2003). It is only then that diffusion can take place. In a social system, the adoption of innovation does not take place simultaneously. Instead, it is a process in which some people adopt the innovation more compared to others. Also, some people adopt the innovation early while others adopt it later. These groups of people boast different characteristics. Thus, in a bid to promote innovation to the target population, awareness of the characteristics that either hinder or accelerate the adoption is vital
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According to Rogers (2003), the rate of adoption refers to the “relative speed with which an innovation is adopted by the members of a social system.” This can be quantified by the number of people that adopt a new idea within a specific period. The rate of adoption is influenced by an innovation’s perceived attributes. A total of five attributes play a crucial role in this process. These attributes include compatibility, relative advantage, trialability, complexity and observability (Rogers, 2003). Other drivers include the nature of communication channels that are used in diffusing the innovation at different stages of the innovation-decision process; the type of innovation-decision; promotion efforts of the change agents responsible for diffusing the innovation; and lastly, the nature of the social system within which diffusion of the innovation takes place. One field in which the diffusion of innovation theory may apply is nursing and healthcare.
Transforming Nursing a nd Healthcare Through Information Technology: Adoption of a New E lectronic H ealth R ecords (EHR) S ystem
There is a consensus that the use of Health Information Technology (HIT) is bound to help improve the quality of healthcare ( Boonstra et al., 2014; Abramson et al., 2012; Greiver et al., 2011). One such technology is the use of EHR systems. These systems take different forms and thus entail a wide array of electronic information systems that are implemented in health care. Likewise, the systems can be embraced by individual organizations, in which case they act as interoperating systems in the affiliated healthcare units. They can also be used nationally or on a regional level. Fundamental healthcare units that are likely to use EHR systems include pharmacies, general practitioner surgeries, hospitals as well as other healthcare providers. Recently, the use of these systems has been embraced by a rising number of hospitals globally. Several factors drive their implementation. These include the promise of availability as well as enhanced patient data integration; the need to improve cost-effectiveness and efficiency; the changing doctor-patient relationship, in which provision of care is undertaken by a team as opposed to a single health care professional; and lastly, the increasing need to function in an environment that is both complex and rapidly changing ( Boonstra et al., 2014). Adoption of EHR systems is also expected to empower nurses by allowing them to incorporate the highest level and most current research into their day to day practice fueling unprecedented efficiency. Likewise, the adoption is likely to improve continuity of care as well as assist in patient-centered care.
The health care system in the United States (U.S) at the forefront of integrating HIT into its clinical delivery of health care. Cohen (2015) reckons that the diffusion of EHR systems among physician is bound to have far-flung implications throughout the health care system. This is particularly the case since physician actions and decisions are bound to influence a significant portion of the overall quality and cost of healthcare. The proponents of HIT hypothesize that if adopted broadly, EHR systems are likely to improve the quality and efficiency of care that is ultimately delivered in the U.S ( Abramson et al., 2012). The inefficiency of the health care system in the U.S “ is exemplified by an extremely high per capita cost in return for modest performance on a wide range of system-level quality measures ” ( Cohen, 2015). This is as compared to other wealthy nations.
The rate of Adoption of the New EHR S ystem
Implementation of EHR systems hospital-wide is undoubtedly a complex process. It is likely to entail the use of a wide range of technical and organizational factors. Notable among these include organizational structure, financial resources, human skills, technical infrastructure as well as coordination ( Boonstra et al., 2014). The complexity of the process is occasioned by such issues as data entry challenges, confidentiality and security concerns, the complexity of medical data and lack of awareness of the importance of HIT. Adoption of the new EHR system is also bound to be challenging due to three core factors. Firstly, the objectives of hospitals are multiple. Secondly, the structures and processes of hospitals are not only complicated but also highly varied. Lastly, the workforce in hospitals is varied with some professionals having high levels of power, expertise, and autonomy. These challenges are likely to result in resistance to the adoption of the new system. This calls for an analysis of the innovation’s five core attributes in a bid to help the nurses understand the importance of adoption.
Relative Advantage
The concern, in this case, is the extent to which EHR systems are perceived to be better than such superseding practices as the use of paper charts. The EHR systems are bound to increase efficiency as well as improve the quality of care ( Boonstra et al., 2014; Greiver et al., 2011). They will also promote interoperability among the adopters.
Compatibility
This attribute pertains to whether the new system is compatible with the adopters' past experiences, existing values, and needs (Rogers, 2003). It is important to note that the EHR systems are aimed at fostering larger stage health care reform and are therefore instruments of change. For instance, they will change focus from offering the best treatment for a single patient to the need to consider value-based strategies that will benefit entire populations (Cohen, 2015). This is a deviation from the traditional value system. Nevertheless, its benefits cannot be overstated.
Complexity
The new EHR systems have been deemed complex. Also, there is a perception that they are unduly complicated and rigid compared to previous practices. However, this is not only true for these systems; it was also the case in previous innovations. Therefore, the perceived complexity should not overshadow the likely benefits of the innovation.
Trialability
The possibility of experimenting with an innovation’s small parts before adopting it fully is crucial in reducing anxiety and risk among the adopters. In line with this, the implementation of EHR systems in hospitals can take place in phases. For instance, at the moment, free trials are available. The feedback received from this will be crucial in the innovation's final roll out.
Observability
For an innovation to be easily adopted, its results have to be visible to others. Availability of results suggests that they are indeed positive. While the successful implementation of EHR systems is more often anonymous and uneventful compared to their failing counterparts, this declined visibility does not imply that the innovation is not beneficial and likely to be successful. Thus, when viewed from a long-term perspective, the benefits of these systems are unquestionable.
The rate of adoption of an innovation is also determined by the extent of promotion efforts spearheaded by the change agents (Rogers, 2003). With regard to adoption of EHR systems, the nurses’ promotion efforts are crucial. Nevertheless, the relationship between these efforts and rate of adoption is not linear and direct. For instance, once opinion leaders adopt the systems, the greatest response is expected. Likewise, after a critical mass of adopters is attained, the innovation spreads with little promotion by the nurses. Ultimately, the role of nurses as change agents in facilitating the adoption of HIT cannot be overstated.
References
Abramson, E. L., McGinnis, S., Edwards, A., Maniccia, D. M., Moore, J., Kaushal, R., & with the HITEC investigators. (2012). Electronic health record adoption and health information exchange among hospitals in New York State. Journal of evaluation in clinical practice , 18 (6), 1156-1162.
Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing electronic health records in hospitals: a systematic literature review. BMC health services research , 14 (1), 370.
Cohen, M. F. (2015). Testing Theories of Innovation Diffusion: Analysis of Physicians' Adoption of Electronic Health Records (Doctoral dissertation).
Greiver, M., Barnsley, J., Glazier, R. H., Moineddin, R., & Harvey, B. J. (2011). Implementation of electronic medical records: Theory-informed qualitative study. Canadian Family Physician , 57 (10), e390-e397.
Rogers, E. M. (2003). Diffusion of Innovations, 5th Edition . Simon and Schuster .
