For the past half century, a model of innovation diffusion, offered by Everett Rogers (1962), has guided the thinking and perspectives of many people who are involved in innovative initiatives of all kinds (ranging from water purification systems to the distribution and use of contraceptive devices to the introduction of new digital technologies in a “flat world”). While popular with certain people (especially in public health), the diffusion of innovation model and research, ironically, has not itself diffused very successfully. It did find some visibility in the writing of Malcolm Gladwell’s Tipping Point (Gladwell, 2002). He offered a somewhat condensed and (some would say) distorted version of Rogers’ diffusion model. Following the publication of Gladwell’s best-selling book, some leaders in the field of medicine began to pay attention and began looking for tipping points.
I propose to do some diffusion of Rogers’ model (hopefully without major distortion) by applying it in a preliminary manner to the approach a physician leader might take in seeking to diffuse an innovative idea. I will borrow from the work of Sally Kuhlenschmidt (2010), who has provided an insightful metaphor regarding diffusion. I begin with the birthplace of new ideas in healthcare.
Innovators/Explorers
These are the men and women who boldly go where no one has gone before (to borrow from the intro to Star Trek). These are the brave (and sometimes foolish and often impractical) people inside (and often outside) health care organizations who declare that they are going to be the first to venture out into the healthcare wilderness, bringing only the bare essentials to stay alive. They usually haven’t gathered much information about the terrain into which they are going to travel. They often are not really clear about why they are moving out into the wilderness or what they expect to find when they get “out there.” As McKenna and Pugno suggest, these innovators and explorers are sorely needed in mid-21st-century health care.
Types of Innovators/Explorers
I would suggest that there are several clusters of innovators/explorers in health care. The first cluster consists of the “idea people.” They produce new ideas that seem to come “out of the blue.” Second, some produce new combinations of old ideas. Third, there are those innovators who bring an old idea over from one field or discipline to another field or discipline, often combining medical research findings with those in biology, psychology, or sociology.
In each of these instances, the Innovator/Explorer is likely to experience a high rate of failure. Either the idea doesn’t work, or there is great resistance to the idea—and it is never accepted. At the extreme, this new idea will produce a paradigmatic revolution that threatens to alter the very way in which we view our world. As Everett Rogers notes, “The more we know about how to do something, the harder it is to learn how to do it differently.”
There is a second cluster of innovators in which we often find physician-leaders. These are the practice leaders. They have innovated not primarily with new ideas, but rather with new programs or new strategies for change. They are the first to offer a training program in the use of a new technology (or the first to fund a new program). They are the first to embrace a new surgical procedure or the first to install a new pay-for-service policy in their hospital. Like their fellow innovators who produce a new idea or product, these practice-leader innovators (as Frist and Shumway note) are rarely received, at least initially, with enthusiastic support. Their new programs and strategies often meet with failure. They feel out of step with everyone else and wonder if they really belong in this hostile healthcare setting.
