1. Diffusion of Innovations Deborah Lekan, MSN, RNC Duke University School of Nursing

2. Duke University School of Nursing, 2008 Objectives Define and describe diffusion of innovations as a model for change. Define and describe diffusion of innovations as a model for change. Identify components of the diffusion model. Identify components of the diffusion model. Describe how the diffusion model can be used to implement evidence-based geriatric nursing practice in LTC. Describe how the diffusion model can be used to implement evidence-based geriatric nursing practice in LTC.

3. Duke University School of Nursing, 2008 “Good ideas do not sell themselves.” do not sell themselves.” (Rogers, E, 1995) Putting evidence-based nursing interventions into practice can be more complicated and difficult than the original research process that generated the interventions.

4. Duke University School of Nursing, 2008 Diffusion of Innovation and Evidence-based Practice Implementation of best practices in organizations is usually- Implementation of best practices in organizations is usually- Left to trial and error; Left to trial and error; Often imposed by external regulations; Often imposed by external regulations; Painfully slow- marked by resistance, incomplete implementation, and failure. Painfully slow- marked by resistance, incomplete implementation, and failure.

5. Duke University School of Nursing, 2008 Diffusion of Innovation and Evidence-based Practice Diffusion of innovation- Diffusion of innovation- Offers a model for guiding implementation of evidence-based practices to ENHANCE successful implementation and sustainability. Offers a model for guiding implementation of evidence-based practices to ENHANCE successful implementation and sustainability. Helps us understand the process of social change. Helps us understand the process of social change. Takes some of the guesswork out of determining what may or may not work. Takes some of the guesswork out of determining what may or may not work.

6. Duke University School of Nursing, 2008 Diffusion of Innovation: Definition The process by which (1) an innovation (2) is communicated through certain channels (3) over time (4) among members of a social system. The process by which (1) an innovation (2) is communicated through certain channels (3) over time (4) among members of a social system. Rogers, E., Diffusion of Innovations, 5 th ed, 2003.

7. Duke University School of Nursing, 2008 Innovation “An idea, practice, or product perceived to be NEW by the relevant individual or group.” “An idea, practice, or product perceived to be NEW by the relevant individual or group.” Idea - new way of thinking about something Idea - new way of thinking about something Practice – new way of doing something Practice – new way of doing something Product - new equipment, device, or technology Product - new equipment, device, or technology

8. Duke University School of Nursing, 2008 Examples of Innovations Products Products Phone technology: digital pager, cell phone, camera phone, Blackberry (phone w/internet), iPod/phone combination Phone technology: digital pager, cell phone, camera phone, Blackberry (phone w/internet), iPod/phone combination Pulse oximetry, Bladderscan, ear thermometer Pulse oximetry, Bladderscan, ear thermometer Practices Practices Restraint free environment  new behavior management techniques Restraint free environment  new behavior management techniques Ideas Ideas Illness and frailty is not a normal part of aging Illness and frailty is not a normal part of aging Pain as the 5 th vital sign Pain as the 5 th vital sign

9. Duke University School of Nursing, 2008 An innovation is all about Perception. If it is new to the user, then it is an innovation.

10. Duke University School of Nursing, 2008 The Rate of Diffusion of Innovations

11. Duke University School of Nursing, 2008 Confirmation and Adoption, Re- invention, or Rejection Contact Awareness Understandin g Knowledge Decision Implementation Persuasion Trial Use Institutionalization Full Scale Use TIME RATE or SPEED of ADOPTION `

12. Duke University School of Nursing, 2008 The Adoption Process: 5 Stages Knowledge —Awareness and understanding of the innovation Knowledge —Awareness and understanding of the innovation Persuasion —Form favorable opinion Persuasion —Form favorable opinion Decision —Try it out Decision —Try it out Implementation —Put it to use Implementation —Put it to use Confirmation—ADOPTION of innovation Confirmation—ADOPTION of innovation or REJECTION, & discontinuation of use or REJECTION, & discontinuation of use

13. Duke University School of Nursing, 2008 Factors Affecting the Rate of Diffusion of Innovations 1. Perceived Innovation Attributes 1. Perceived Innovation Attributes 2. Type of Innovation- Decision 2. Type of Innovation- Decision 3. Communication Channels 3. Communication Channels 4. Nature of Social System 4. Nature of Social System 5. Change Agent Efforts 5. Change Agent Efforts

14. Duke University School of Nursing, 2008 1. Perceived Attributes of the Innovation Relative Advantage Relative Advantage Compatability Compatability Complexity Complexity Triability Triability Observability Observability

15. Duke University School of Nursing, 2008 Relative Advantage How is the innovation BETTER than the current process or technology—the status quo? How is the innovation BETTER than the current process or technology—the status quo? “Everything is fine, so I’m not interested!” “Everything is fine, so I’m not interested!” “I have my own system that works”. “I have my own system that works”. “No point in changing just for the sake of change”. “No point in changing just for the sake of change”. Example: Digital vs mercury thermometer-has many advantages for busy nurses. Example: Digital vs mercury thermometer-has many advantages for busy nurses.

16. Duke University School of Nursing, 2008 Compatability Is the innovation consistent with existing values, past experiences, and the needs of the adopters? Is the innovation consistent with existing values, past experiences, and the needs of the adopters? “We tried that and it didn’t work” “We tried that and it didn’t work” “I used this device before and it was not accurate, so I don’t think this new version will be much better” “I used this device before and it was not accurate, so I don’t think this new version will be much better” Example: The 0-10 pain “thermometer” is similar to how nurses have assessed pain in the past (rating severity as mild, moderate, severe). Example: The 0-10 pain “thermometer” is similar to how nurses have assessed pain in the past (rating severity as mild, moderate, severe).

17. Duke University School of Nursing, 2008 Complexity Is the innovation easy to use and simple to understand? Is the innovation easy to use and simple to understand? “This assessment form is too detailed and wordy” “This assessment form is too detailed and wordy” “I use my own wound assessment chart because the new one is too long and complicated” “I use my own wound assessment chart because the new one is too long and complicated” Example: Staff are implementing new assessment guidelines for S&S of Heart Failure. Use an acronym as a memory aid. Example: Staff are implementing new assessment guidelines for S&S of Heart Failure. Use an acronym as a memory aid.

18. Duke University School of Nursing, 2008 Try this: How can you make something that is complex, more simple? Mrs. Jones is in Acute Heart Failure and you need to do a thorough assessment and call the MD/NP. What will you assess? Mrs. Jones is in Acute Heart Failure and you need to do a thorough assessment and call the MD/NP. What will you assess? Can you name at least 5 signs and symptoms of Acute Heart Failure that should be assessed? Can you name at least 5 signs and symptoms of Acute Heart Failure that should be assessed?

19. Duke University School of Nursing, 2008 Answer: Acute Heart Failure S&S Shortness of breath Shortness of breath Congestion, coughing up frothy sputum Congestion, coughing up frothy sputum Pale, cold clammy skin Pale, cold clammy skin Swelling in the legs Swelling in the legs Tachycardia, thready pulse Tachycardia, thready pulse Change in mental status, forgetful, confused Change in mental status, forgetful, confused Decreased urine output Decreased urine output Tired, weak, sleepy Tired, weak, sleepy There are more! How can you remember all of these so you can do a thorough assessment?

20. Duke University School of Nursing, 2008 FFatigue Fast pulse A Activities of Daily Living  Appetite poor CCoughCongestionConfusion Chest Pain EEdema Weight gain Elimination-decreased output S Shortness of Breath HEART FAILURE Signs & Symptoms

21. Duke University School of Nursing, 2008 Trialability Can the innovation be tried out on a limited basis? Can the innovation be tried out on a limited basis? “I can’t do all that-it’s too much to do!” “I can’t do all that-it’s too much to do!” “I don’t have time, that idea will never work.” “I don’t have time, that idea will never work.” Example: Conduct UI Assessment on several patients and try out prompted voiding (PV) on 2 residents on 1 unit who are most likely to be responsive. Once staff see that it is feasible, and resident responses are good, staff are more likely to be persuaded to continue prompted voiding. Example: Conduct UI Assessment on several patients and try out prompted voiding (PV) on 2 residents on 1 unit who are most likely to be responsive. Once staff see that it is feasible, and resident responses are good, staff are more likely to be persuaded to continue prompted voiding.

22. Duke University School of Nursing, 2008 Observability Are the results or outcomes visible? Are the results or outcomes visible? “I’m not convinced that it works!” “I’m not convinced that it works!” “How will we know if it makes a difference?” “How will we know if it makes a difference?” Example: Have staff record a UI Bladder Diary for 2 weeks on those 2 residents on PV & chart the results on a graph. Show to staff and discuss resident outcomes. Call it “TPR for the PVP”—or the “vital signs” for the PV program. Example: Have staff record a UI Bladder Diary for 2 weeks on those 2 residents on PV & chart the results on a graph. Show to staff and discuss resident outcomes. Call it “TPR for the PVP”—or the “vital signs” for the PV program.

23. Duke University School of Nursing, 2008 Re-invention The degree to which an innovation is changed/modified during implementation… “tweaking.” The degree to which an innovation is changed/modified during implementation… “tweaking.” Re-invention may foster adoption when users participate in customizing a better fit of the innovation to their work routines. Re-invention may foster adoption when users participate in customizing a better fit of the innovation to their work routines. Danger of altering the innovation to the extent that it has no impact. Danger of altering the innovation to the extent that it has no impact.

24. Duke University School of Nursing, 2008 Example of Re-invention Modify prompted voiding schedule from “Q2 hours”, to “before/after meals and bedtime”, to accommodate the resident’s schedule. Modify prompted voiding schedule from “Q2 hours”, to “before/after meals and bedtime”, to accommodate the resident’s schedule. Modify oral assessment tool to reflect setting of care (delete “referral to dentist” in some instances, for example, in LTC setting). Modify oral assessment tool to reflect setting of care (delete “referral to dentist” in some instances, for example, in LTC setting).

25. Duke University School of Nursing, 2008 Re-invention Modify the Heart Failure FACES chart to include Modify the Heart Failure FACES chart to include include symptoms relevant to elderly, or include symptoms relevant to elderly, or be more explicit, e.g., edema & weight gain. be more explicit, e.g., edema & weight gain.

26. Duke University School of Nursing, 2008 FFatigue A Activity limited C Chest congestion E Edema or ankle swelling S Shortness of breath FFatigue Fast pulse* A Activities of Daily Living Appetite poor* CCough*CongestionConfusion* Chest Pain* EEdema Weight gain* Elimination-decreased* S Shortness of Breath Reinvention * Added to original list

27. Duke University School of Nursing, 2008 2. Type of Innovation-Decision Optional—voluntary, individual choice. Optional—voluntary, individual choice. Collective—decide as a group, consensus. Collective—decide as a group, consensus. Authoritative—top down decision, must do it! Authoritative—top down decision, must do it!

28. Duke University School of Nursing, 2008 3. Communication Channels Mass media-public information Mass media-public information Creates awareness, increases knowledge and favorable impression about the innovation Creates awareness, increases knowledge and favorable impression about the innovation Interpersonal--local interactions with near peers Interpersonal--local interactions with near peers Strongly influences personal opinion through persuasion Strongly influences personal opinion through persuasion Sources: peers and opinion leaders Sources: peers and opinion leaders Communication channels provide information to decrease uncertainty about the innovation. Communication channels provide information to decrease uncertainty about the innovation.

29. Duke University School of Nursing, 2008 Mass Media Communication Education: General information, policies, procedures, documentation Education: General information, policies, procedures, documentation Staff meetings: Reports, organizational rationale/goals Staff meetings: Reports, organizational rationale/goals Written: Charts, forms, newsletters Written: Charts, forms, newsletters Verbal: Announcements, focus groups, task forces Verbal: Announcements, focus groups, task forces Promotional campaigns: Posters, fact sheets, raffles, games, contests Promotional campaigns: Posters, fact sheets, raffles, games, contests

30. Duke University School of Nursing, 2008 Interpersonal Communication Most interaction is among “near peers”. Most interaction is among “near peers”. Connections among staff: number, frequency, content of interactions. Dense networks are more functional. Connections among staff: number, frequency, content of interactions. Dense networks are more functional. Interactions are local but effects have a system- wide effect. Interactions are local but effects have a system- wide effect.

31. Duke University School of Nursing, 2008 Interpersonal Communication Mass Media Communication

32. Duke University School of Nursing, 2008 4. Nature of Social System A social system is a group of inter-related agents or people engaged who are engaged together to achieve a common goal. A social system is a group of inter-related agents or people engaged who are engaged together to achieve a common goal. The social structure and quality of inter- relationships determines the flow of information and diffusion of innovation The social structure and quality of inter- relationships determines the flow of information and diffusion of innovation The role of opinion leaders and change agents influences diffusion and adoption. The role of opinion leaders and change agents influences diffusion and adoption.

33. Duke University School of Nursing, 2008 Typical Relationship Patterns in NH- Top Down, Often Thin Resident NHA/DON RN Supervisor Interdisciplinary Team MDS Nurse NALPN

34. Duke University School of Nursing, 2008 Rich Connections Among Staff & Mgt- Vertical,Dense Resident & Family NHA/DON RN Supervisor Interdisciplinary Team MDS Nurse NALPN Dietary, Housekeeping, Maintenance

35. Duke University School of Nursing, 2008 Communication Networks Legitimate system Legitimate system Chain of command for flow of information- information moves up or down the hierarchy Chain of command for flow of information- information moves up or down the hierarchy Shadow system Shadow system Rumor mill & gossip grapevine--information crosses hierarchical boundaries Rumor mill & gossip grapevine--information crosses hierarchical boundaries Can be made up of many loose connections Can be made up of many loose connections

36. Duke University School of Nursing, 2008 Opinion Leaders Opinion Leadership- Opinion Leadership- Individuals within peer group who are admired, imitated, & identified as a reliable source of information. Individuals within peer group who are admired, imitated, & identified as a reliable source of information. They exert a strong influence on decision to adoption. They exert a strong influence on decision to adoption.

37. Duke University School of Nursing, 2008 Opinion Leaders… Communicate their approval or disapproval of an innovation. Communicate their approval or disapproval of an innovation. Reduce uncertainty about what will happen if the innovation is adopted. Reduce uncertainty about what will happen if the innovation is adopted. Evaluate the innovation and give it thumbs up or down. Evaluate the innovation and give it thumbs up or down. The “majority” responds by rapidly adopting. The “majority” responds by rapidly adopting. The spread of an innovation hinges on whether opinion leaders vouch for it. The spread of an innovation hinges on whether opinion leaders vouch for it.

38. Duke University School of Nursing, 2008 Change Champions May not be an opinion leader or an “insider”, May not be an opinion leader or an “insider”, BUT, may know a lot about the innovation, think it is a good idea, or have personal experience with it. Have a strong commitment to the innovation and will enthusiastically promote it. Have a strong commitment to the innovation and will enthusiastically promote it. Can be very effective in persuading others. Can be very effective in persuading others.

39. Duke University School of Nursing, 2008 Change Agent Develop a perceived need for change among members of the organization Develop a perceived need for change among members of the organization Diagnose problems in current practice Diagnose problems in current practice Work effectively with opinion leaders and direct care staff Work effectively with opinion leaders and direct care staff Address negative feedback about the innovation by uncovering perceptions, barriers and facilitators Address negative feedback about the innovation by uncovering perceptions, barriers and facilitators Promote the innovation Promote the innovation

40. Duke University School of Nursing, 2008 Describing People in the System: Adopter Categories Degree to which an individual is relatively early in adoption of an innovation, compared to others in the social system. Degree to which an individual is relatively early in adoption of an innovation, compared to others in the social system. Early adopters and opinion leaders lead the change process, and by their example, others follow. Early adopters and opinion leaders lead the change process, and by their example, others follow.

41. Duke University School of Nursing, 2008 Adopter Categories: Adopter groups: Innovators, early adopters, early majority, late majority, laggards Adopter groups: Innovators, early adopters, early majority, late majority, laggards Click on this link to learn more about these groups http://images.google.com/imgres?imgurl=http://www.loden.com/images/adoption.gif&imgrefurl=http://www.lo den.com/innov.html&h=280&w=415&sz=8&tbnid=D9j4x4wvwsYJ:&tbnh=81&tbnw=121&hl=en&start=1 9&prev=/images%3Fq%3Dchange%2Bagents%26svnum%3D10%26hl%3Den%26lr%3D%26client%3Dfiref ox-a%26rls%3Dorg.mozilla:en-US:official_s%26sa%3DG Number of people within adopter groups Number of people within adopter groups

42. Duke University School of Nursing, 2008 Types and Description Innovators –visionary; eager to explore & willing to try new things, experiment & on occasion risk failure. Innovators –visionary; eager to explore & willing to try new things, experiment & on occasion risk failure. Early adopters -well connected/respected by peers; tend to be opinion leaders, willing to try new things if benefit is verified, likes to influence & lead change. Early adopters -well connected/respected by peers; tend to be opinion leaders, willing to try new things if benefit is verified, likes to influence & lead change. Early majority –deliberate; will follow with peer experience & expert endorsement, are an important link to later adopters. Early majority –deliberate; will follow with peer experience & expert endorsement, are an important link to later adopters. Late majority -skeptical and cautious; willing to adopt with social pressure & convincing information from opinion leaders. Late majority -skeptical and cautious; willing to adopt with social pressure & convincing information from opinion leaders. Laggards -traditionalist; suspicious & uncertain of innovation, peer pressure necessary, seeks stability & “good old days”. Laggards -traditionalist; suspicious & uncertain of innovation, peer pressure necessary, seeks stability & “good old days”. People place into different categories depending on the innovation.

43. Duke University School of Nursing, 2008

44. Exercise: Which Adopter Category are you regarding pain management in the Elderly? Adopter Category Innovation InnovatorEarly Adopter Early Majority Late Majority Laggard Assessment of pain as the 5th vital sign Use of Ketoprofen cream for local arthritis pain as standing order Use of Pain Visual Analogue Scale to rate pain from 0-10 Use of hot & cold treatment for local pain relief. Abandonment of Demeral for analgesia in elderly

45. Duke University School of Nursing, 2008 Stop and Reflect: Using the Diffusion of Innovation Model helps you… Identify innovation attributes, Identify innovation attributes, Uncover facilitators and barriers Uncover facilitators and barriers Gain understanding about relationships between the innovation, individuals and the social system Gain understanding about relationships between the innovation, individuals and the social system Recognize strengths in the system Recognize strengths in the system Speed the rate of adoption of the innovation Speed the rate of adoption of the innovation

46. Duke University School of Nursing, 2008 How can the Diffusion of Innovations Model help promote Evidence-based Geriatric Nursing Practice in LTC? How can the Diffusion of Innovations Model help promote Evidence-based Geriatric Nursing Practice in LTC?

47. Duke University School of Nursing, 2008 Recognize that most people tend to not desire change! Human nature gravitates to reducing and managing uncertainty.

48. Duke University School of Nursing, 2008 Using the Diffusion of Innovation Model Analyze Innovation Attributes and barriers/facilitators relative to specific groups: Analyze Innovation Attributes and barriers/facilitators relative to specific groups: RNs, LPNs, CNAs RNs, LPNs, CNAs Other disciplines and ancillary staff Other disciplines and ancillary staff Management Management Residents, families Residents, families Regulators and surveyors Regulators and surveyors

49. Duke University School of Nursing, 2008 Using the Diffusion of Innovation Model Analyze the Social Network Analyze the Social Network Opinion leaders & change champions Opinion leaders & change champions Adopter Categories-early adopter & early majority, laggards Adopter Categories-early adopter & early majority, laggards Work processes and routines Work processes and routines Information flow, communication patterns— increase local interactions Information flow, communication patterns— increase local interactions Amount of connectivity among staff Amount of connectivity among staff Diversity of staff interactions-across levels, disciplines, roles Diversity of staff interactions-across levels, disciplines, roles

50. Duke University School of Nursing, 2008 Using the Diffusion of Innovation Model Assess Communication Channels Assess Communication Channels Who tends to talk most to each other? Who tends to talk most to each other? Who is the typical ‘go to person’ for information? Who is the typical ‘go to person’ for information? Who tends to stir up controversy or ‘gossip’? (rumor mill) Who tends to stir up controversy or ‘gossip’? (rumor mill) Are all of the right people talking to each other? Are all of the right people talking to each other? Is information isolated from those who need it? Is information isolated from those who need it? Is there a ‘shadow system’?...an informal routing of communication that is not or top-down/bottom-up, but is based on personal connections, cliques, or other factors? Is there a ‘shadow system’?...an informal routing of communication that is not or top-down/bottom-up, but is based on personal connections, cliques, or other factors?

51. Duke University School of Nursing, 2008 Some Strategies to promote adoption Education methods Education methods Quality improvement methods Quality improvement methods

52. Duke University School of Nursing, 2008 Using the Diffusion of Innovation Model Education methods Education methods Education necessary but not enough to change practice or lead to adoption. Education necessary but not enough to change practice or lead to adoption. Mass media and didactic information--increases knowledge and awareness. Mass media and didactic information--increases knowledge and awareness. Interpersonal approaches—promotes behavior change & adoption of innovation Interpersonal approaches—promotes behavior change & adoption of innovation Experiential learning Experiential learning Bedside clinical teaching Bedside clinical teaching Nursing rounds Nursing rounds Peer learning--mixed teams co-teach a topic Peer learning--mixed teams co-teach a topic

53. Duke University School of Nursing, 2008 Quality Improvement Tools to use in the DOI Model Rationale Rationale Relative Advantage & Compatability can be demonstrated Relative Advantage & Compatability can be demonstrated Tools can signal processes or procedures that are too complex, and need to be simplified Tools can signal processes or procedures that are too complex, and need to be simplified Can enhance Trialability by providing evidence Can enhance Trialability by providing evidence Increases Observability by having output to view Increases Observability by having output to view Commonly used tools Commonly used tools Fishbone chart to identify problems or barriers Fishbone chart to identify problems or barriers Audits to assess practice patterns & staff adherence Audits to assess practice patterns & staff adherence Quality control charts to document outcomes Quality control charts to document outcomes Run chart to map progress after interventions Run chart to map progress after interventions

54. Duke University School of Nursing, 2008 PROBLEM Domain ADomain BDomain C Domain EDomain FDomain D Fishbone Chart Template

55. Duke University School of Nursing, 2008 Pain Assessment in elderly-- not being done well StaffingCommunicationLPN Role Pain FormAttitudesDocumentation Too complex, too long Hard to do in elderly No time, too much work MD telephone calls a problem Sporadic charting LPN role unclear Scope of practice issues No RN Supervisor position, few RNs Knowledge about pain limited among all staff Shift work mentality Rigid work routines Don’t understand pain in pts w/chronic disease Cognitively-impaired do not have pain CNAs, LPNs & RNs don’t share info Chronic pain poorly managed Charge nurse tied to med cart Fishbone Chart Worked Example

56. Duke University School of Nursing, 2008 Audit-- Record Review Prompted Voiding Form for patient on Q2hour toileting program Patient Name Dry Slightly Wet Soaking Wet Amount Voided Toileted? 6amx200Yes 7am 8amx100Yes 9am 10 am No 11 am x 12 noon etc....x200Yes Strong bladder urge

57. Duke University School of Nursing, 2008 Using a Quality Control Chart to Track Outcomes

58. Duke University School of Nursing, 2008 Using a Run Chart to Track Outcomes Medical Review of North Carolina, (2002) Mills PD & Waldron J INTERPRETATION: Fall assessments conducted after staff training may be influencing decreased falls rate.

59. Duke University School of Nursing, 2008 What FACILITATES Adoption of an Innovation? It is useful, better than the status quo It is useful, better than the status quo It is easy to use or do, & simple to understand It is easy to use or do, & simple to understand Is congruent with values or previous experiences Is congruent with values or previous experiences Can see results or outcomes Can see results or outcomes Can try it out & modify it to accommodate your needs Can try it out & modify it to accommodate your needs Favored by opinion leaders & change champions Favored by opinion leaders & change champions Active and diverse social networks help promote a favorable opinion Active and diverse social networks help promote a favorable opinion

60. Duke University School of Nursing, 2008 What INTERFERES with Adoption of an Innovation? Perception that it is not beneficial or better than what is currently being done Perception that it is not beneficial or better than what is currently being done Difficult to understand or do Difficult to understand or do Does not align with values or beliefs Does not align with values or beliefs Unable to try out on small scale Unable to try out on small scale The innovation or its results are not visible The innovation or its results are not visible Not endorsed by Opinion Leaders or Management Not endorsed by Opinion Leaders or Management

61. Duke University School of Nursing, 2008 The Big Picture In the next slide, you will see a visual display of the diffusion model that highlights the key elements that influence the adoption of innovations In the next slide, you will see a visual display of the diffusion model that highlights the key elements that influence the adoption of innovations In what ways could this model help you evaluate a new idea or care practice for implementation in your care setting? In what ways could this model help you evaluate a new idea or care practice for implementation in your care setting?

62. Duke University School of Nursing, 2008 Stop and Reflect: Using the Diffusion of Innovation Model Reduces uncertainty about the innovation. Reduces uncertainty about the innovation. Proactively addresses potential barriers, pitfalls or problems. Proactively addresses potential barriers, pitfalls or problems. Identify staff perspectives, strengths and limitations that may affect implementation. Identify staff perspectives, strengths and limitations that may affect implementation. By addressing key aspects in the model, you can By addressing key aspects in the model, you can Speed up rate of adoption for getting new ideas into practice, and increase sustainability Speed up rate of adoption for getting new ideas into practice, and increase sustainability

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64. Let’s Recap the High Points ! Diffusion of Innovations is a theory that helps explain the social process of CHANGE. Diffusion of Innovations is a theory that helps explain the social process of CHANGE. DIFFUSION is the process by which an innovation is communicated through certain channels over time among members of a social system. DIFFUSION is the process by which an innovation is communicated through certain channels over time among members of a social system. An INNOVATION is an idea, practice or object that is perceived as NEW by the individual. An INNOVATION is an idea, practice or object that is perceived as NEW by the individual. The purpose of the model is to increase the speed or rate of adoption of an innovation.

65. Duke University School of Nursing, 2008 Summary: Diffusion is a useful Model to- Systematically assess the barriers and facilitators within the organization and among individuals and groups. Systematically assess the barriers and facilitators within the organization and among individuals and groups. Identify strengths in the social network to promote benefits of innovation. Identify strengths in the social network to promote benefits of innovation. Strategically design & plan interventions to facilitate adoption of evidence-based practices. Strategically design & plan interventions to facilitate adoption of evidence-based practices.

66. Duke University School of Nursing, 2008 References Short overview of Diffusion of Innovations (University of South Florida) Short overview of Diffusion of Innovations (University of South Florida) http://hsc.usf.edu/~kmbrown/Diffusion_of_Innovations_Overview.htm http://hsc.usf.edu/~kmbrown/Diffusion_of_Innovations_Overview.htm http://hsc.usf.edu/~kmbrown/Diffusion_of_Innovations_Overview.htm The classic text: Diffusion of Innovations, 5th Ed. 2003, Everett M. Rogers The classic text: Diffusion of Innovations, 5th Ed. 2003, Everett M. Rogers http://www.amazon.com/exec/obidos/tg/detail/-/0743222091/104- 0730562-2628704?v=glance http://www.amazon.com/exec/obidos/tg/detail/-/0743222091/104- 0730562-2628704?v=glance http://www.amazon.com/exec/obidos/tg/detail/-/0743222091/104- 0730562-2628704?v=glance http://www.amazon.com/exec/obidos/tg/detail/-/0743222091/104- 0730562-2628704?v=glance Excellent summary of Roger’s book (Iowa State U) Excellent summary of Roger’s book (Iowa State U) Part I: http://www.soc.iastate.edu/Sapp/Diffusion1.html Part I: http://www.soc.iastate.edu/Sapp/Diffusion1.htmlhttp://www.soc.iastate.edu/Sapp/Diffusion1.html Part II: http://www.soc.iastate.edu/Sapp/Diffusion2.html Part II: http://www.soc.iastate.edu/Sapp/Diffusion2.htmlhttp://www.soc.iastate.edu/Sapp/Diffusion2.html