Evaluation of Integrated Resource Framework Test Sites

APPENDIX 2. COMPONENTS OF THE DIFFUSION OF INNOVATION MODEL FOR COMPLEX INNOVATIONS IN HEALTH SERVICES

1. Material properties of the IRF

To be successfully and widely adopted, the IRF must include key functionality and work smoothly and efficiently under real conditions of use.

2. Attributes of the IRF as an innovation

To be successfully and widely adopted, the IRF must be seen by potential adopters as having:

• Relative advantage (that is, clear benefits over existing technologies)
• Simplicity
• Compatibility with existing values and ways of working
• Trialability (can be tried out on a limited basis "without obligation")
• Observability (benefits can be seen directly)
• Potential for reinvention (capacity for users to customise and adapt it)

3. Concerns of potential adopters

Adoption is a process, not a one-off event, and is influenced by concerns, including:

• Before adoption - what are its properties and potential benefits? What will it cost me?
• During early use - how do I make it work? When and how should I use it?
• During established use - how can I alter or improve it?

4. Communication and influence

A person's decision to adopt an innovation is influenced by:

• Mass media (press, mail shots), which can raise awareness
• Interpersonal influence (by champions, opinion leaders, for example), which can change people's attitudes towards adoption

5. Organisational antecedents for innovation

Organisations may be more or less innovative. Differences are explained by several factors:

• Absorptive capacity for new knowledge
• Leadership and management
• Risk taking climate
• Effective data capture systems
• Slack resources

6. Organisational readiness for innovation

An organisation must be "ready" for a specific innovation. Readiness includes:

• Innovation-system fit
• Tension for change
• Balance between supporters and opponents
• Specific preparedness

7. The implementation and routinisation process

Implementing a complex innovation, and making sure it becomes business as usual, is a highly non-linear process, typically characterised by shocks and setbacks. Critical success factors include:

• Appropriate change model (balance between "make it happen" and "let it emerge")
• Good project management
• Autonomy of frontline teams
• Human resource factors, especially the selection, retention, continuity, and training of staff
• Alignment between new and old routines

8. Linkage

Innovation is more likely when there is:

• Early and ongoing dialogue between the developers of the innovation, the change, agents charged with promoting its adoption, and the end users
• Communication within the organisation and between similar organisations

9. The wider environment

Innovation in organisations is more likely when a "following policy wind," a conducive socio political climate, and specific incentives and mandates at national level are present

(Adapted from Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organisations: systematic literature review and recommendations for future research. Millbank Q 2004;82:581-629.)