While the “bandwagon” phenomenon can initially be very gratifying to someone who has been laboring for many years to get a new healthcare procedure or program accepted, it can also create major problems—because this new procedure or program is typically not fully understood by the Late Majority and is often misused. This can lead to “casualties.” For instance, the prescription of a new medication may become an “in-thing”; however, Late Majority joggers are likely to over-prescribe this medication. The bandwagon can also lead to failure and anger: “Why doesn’t this darn thing work?” Alternatively, uncritical Late Majority acceptance of a new procedure or product can lead to neglect or inefficiency. The newly purchased top-of-the-line diagnostic tool, for instance, may sit unused. The fancy new hand-held device might serve as nothing more than an alarm.
Role of Expert and Leader
What does all of this mean in terms of working with the Late Majority? First, it means that the physician leader must spend quite a bit of time exploring with those in the Late Majority the reasons for wanting to adopt the innovation. The physician leader can help those in the Late Majority to discover a legitimate and potentially beneficial reason for adopting the innovation. Even if the innovation is adopted for use by members of the Late Majority, the physician leader often must help members of this group differentiate between fads and foundations (viable ideas) in their organization. How does a physician leader differentiate between perspectives and practices that are sound (based on a solid base of valid and useful information) and those that are based on nothing more than good marketing and superficial acceptance by many people in the healthcare world?
How does one determine that a new idea is aligned with the mission, vision, values and purposes of one’s organization? When is a new idea being accepted not because it is based on a solid (and organizationally aligned) foundation, but because it is convenient, low-cost, exciting, or not very complicated? A physician leader can provide invaluable service in helping members of their organization address these difficult issues and discern which healthcare procedures and programs are viable and which are not viable.
Second, the security anchor identified by Schein is even heavier for the Late Majority client or subordinate than it was for members of the Early Majority. Those in the Late Majority/Burgher population often have a very primitive sense of what they expect from their organization in terms of job stability, public recognition, and rewards. Schein writes about the psychological contract that exists in the head and heart of members of organizations. This contract consists of the expectations (conscious and unconscious) that the member has of what they will receive from the organization in exchange for the work they do and attitude they exhibit on behalf of the organization’s welfare.
While I agree with Schein’s observation that these expectations exist in virtually all organizations, I propose that it is not a psychological contract, but rather an enduring covenant that is not easily renegotiated in a health care system (Cassatly and Bergquist,2011). Furthermore, as a covenant that is often unconsciously held, it is not revoked by the organization and is considered a betrayal if not honored by the organization’s leaders. Anger, harassment, and even violence in an organization can often be attributed to this sense of betrayal. Someone who comes from the Late Majority inevitably has embraced a covenant that is unconscious, non-negotiable, and considered external to the Late Majority’s own personal and collective psyche.
