Components of the diffusion of innovation model | Strategies used to enhance implementation | Key themes |
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1. Attributes of the innovation To be successfully and widely adapted, an innovation must be seen by potential adopters as having: • Relative advantage • Simplicity • Compatibility with existing values and ways of working • Trialability • Observability • Potential for reinvention | • theory-driven program based on current evidence • well-trained diabetes educators • integrated in primary care • no financial threshold for patients • possibility of home visit | • extra administrative workload • motivation of patients requires extra consultation time • doubts about the added value of the service • potential benefits not visible enough • distance to the centre |
2. Concerns of potential adopters Adoption is a process, not a one-off event, and is influenced by concerns, including: • Prior to 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?) | • interdisciplinary care protocol with clear job descriptions • strengthening of GPs' role in diabetes care • referral by GP obliged • advice regarding the target groups | • fear of further fragmentation of diabetes care • fear of negative interference with the doctor-patient relationship • fear of losing control over therapy • uncertainty about job boundaries • doubts about which of their patients will benefit (the most) • lack of motivational skills • patients are not asking for the service themselves |
3. Communication and influence An individual's decision to adopt an innovation is influenced by: • Mass media • Interpersonal influence | • information campaign targeting GPs, patients and other health care providers | • confusion regarding the aims of the project • limited awareness of the program among patients • negative attitude of peers towards the program |
4. 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 | • establishment of a local steering group • appointment of a program manager • involvement of regional stakeholders • sufficient financial resources (for the course of the pilot) | • no tradition with the initiation of care innovation in primary care |
5. Organisational readiness for innovation Readiness includes: • Innovation-system fit • Tension for change • Balance between supporters and opponents • Specific preparedness | • survey among health care providers at the start of the project, exploring the needs regarding diabetes care in the region | • non-referral as a way to express dissatisfaction with their current role in the health care system • disbelief that project results can influence health policy |
6. The implementation 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 of change model • Good project management • Human resource issues • Alignment between new and old routines | • establishment of a local steering group • establishment of study groups • appointment of a program manager • balanced implementation plan ('help it happen' strategy) | • tend to forget about the service |
7. Linkage Innovation is more likely when there is: • Early and ongoing dialogue between developers of the innovation, the change agents charged with promoting its adoption, and its users • Communication within the organisation and between similar organisations | • involvement of GPs in program development, initial via their QPRGs, later on via the study groups • involvement of all health care providers involved in diabetes care via study groups | • not used to being involved in care innovation development |
8. The broader context Innovation in organisations is more likely to be successful when there is a 'following policy wind', a conductive socio-political climate, and specific incentives and mandates at national level | • integration of the program in primary care • financial resources provided by project funding • regular contact with the commissioners of the study | • feelings of frustration and insecurity regarding GPs' position and role in health care • disbelief that project results can influence health policy • uncertainty about continuity of the program |