disruptive innovation, graduate education, positive disruption, tipping point



  1. Thompson, Cathy J. PhD, RN, CCNS, CNE

Article Content

In previous columns, I started a conversation about disruptive innovation (DI) in higher education1 and about the disruptive trajectory of online education, in particular, to traditional college course offerings.2 The rise of online education and the growing acceptance of online courses among students are a fact. Of the 5.8 million US college students enrolled in online courses in 2015, 48% were taking online courses exclusively3; in 2013, only 13% of students were enrolled exclusively in distance education courses.4 However, despite the rapid increase in the demand for online learning, faculty and administrators have been resistant to the pedagogical approach of online learning, even questioning the "legitimacy of online education."3(p6) When online nursing education was in its infancy, faculty had legitimate concerns about teaching online-some of those concerns were due to inadequate guidance and development of how to create a quality online course. However, as we see from student satisfaction studies, faculty have become more skilled with the online learning environment and the quality of current courses is the same or better than that of traditional face-to-face courses.5-7 Admittedly, there still are obstacles to teaching online; however, as distance education rapidly becomes the learning format of choice,3,8,9 faculty must be proactive in preparing for this new reality.


In response to a 2015 survey of online education,3 71% of faculty indicated that online learning was not a valid form of education. We can use Rogers'10 innovation adoption bell curve transposed with the cumulative S-shaped curve of adoption to look where we might be, for the acceptance rate of online education. The innovators and the early adopters would make up 16% of the faculty population adopting online learning, with the additional 13% reflected in the leading edge of the early majority (29% total; Figure 1). The "take-off point" (aka threshold point or tipping point) for diffusion of an interactive innovation within a system is frequently reported in a range of 10% to 20%,10,11 although it is well known that the rate of adoption for healthcare technologies varies widely.11 Rogers10 found that because there is great variation in diffusion depending on the innovation itself and the sector for which it is intended, there seemed to be no magic number at which an innovation always takes off. However, scientists at Rensselaer Polytechnic Institute12,13 have reported that just 10% of a defined population committed to "an unshakeable belief"12([P]1) is all that is needed to trigger the adoption of that belief in the rest of the population-"where minority belief becomes majority opinion."12([P]1)Committed is the key word here. This percentage holds regardless of "the type of network in which the opinion holders are working[horizontal ellipsis]or where that opinion starts."12([P]5)

Figure 1 - Click to enlarge in new windowFIGURE 1. Rogers' innovation adoption bell curve with S-shaped adoption curve. Source: Rogers,

Social channels have a great impact on the diffusion rate. According to Rogers,10 individual adoption is more likely to occur when other individuals, especially opinion leaders, within the adopter's network are also using the innovation. The Babson and Quahog research group's survey3 noted that the acceptance of online education coincided with the institution's online learning offerings, so those institutions without a critical mass of faculty advocating for online education will likely have a slower rate of adoption. If we apply the evidence though, if at least 10% of the faculty is committed to online education, that 10% minority can prevail to become the majority opinion. As the predictions of online education point toward its upending of the traditional college model of education (ie, a disruptive trajectory),8,9 institutions will need to be innovative and proactive if they want to keep their market share of students.14


How does an innovation acquire critical mass to reach the tipping point? Rogers10(p327) recommended the following strategies: (a) get the top-level leaders to champion and adopt the innovation; (b) provide resources for the potential adopters to decrease the perception of individual cost; (c) communicate that the use of the innovation is "inevitable, [horizontal ellipsis]very desirable," imminent, and/or that critical mass has already been reached; (d) encourage formed groups to use and promote the innovation, and (e) provide encouragement and incentives for early adoption. These strategies can be used by institutions and individual faculty to address some of the barriers that hinder faculty from embracing and adopting a good attitude toward online learning (see Figure 2).

Figure 2 - Click to enlarge in new windowFIGURE 2. Strategies for attaining critical mass for online education acceptance. APN indicates advanced practice nurse; LMS, learning management system; TA, teaching assistant. Source: Rogers,


Dr Renu Khator, chancellor of the University of Houston System and president of the University of Houston, talked about disruptive transformations in the university system.14 Her advice for dealing with transformational change is specific to attitude.


Attitude may be one of the most valuable tools with which we have to work with as this ambiguous and demanding future comes racing toward us. Our attitude plays a significant role in determining how we react, how we respond and, ultimately, whether we prevail.(p4.2)


Khator stated that universities should identify the "shortcomings of the [higher education] delivery system,"14(p4.3) to include pedagogical approaches, and must stay true to the core mission of the university to stay relevant to effectively serve the stakeholders and the greater community. Our student community is telling us they prefer online education.3,5,7-9


Khator14 identified 4 reactive attitudes that can hinder our forward progress: ignorance, arrogance, victimization, and panic. Possible solutions to those reactive responses are to keep current with the global, societal, technological, and other trends that have a potential to impact us in higher education; keep an open mind to possibilities of better ways to teach and learn; eliminate the victim mentality about change in general; and to answer the question, what is the real issue/problem, and others? instead of overreacting and doing "something" that may not solve the true underlying issue.14



So after our attitude adjustment, how can we lead and bring about positive change? How does one become a positive disruptor? First, there are a few things about the theory of DI to keep in mind. Christensen et al8 tell us to remember the following:


* Disruptive innovation does not happen overnight. Disruptive innovation has to be planned and is a process that takes time to develop-from the idea, to the development and refinement of that idea, to a gradual erosion of the status quo, and finally to acceptance and profitability.


* The DI model is different from that used by the status quo. In healthcare, the general practitioner's office is vastly different from the nurse practitioner/physician-assistant staffed clinics found inside grocery stores, pharmacies, and retail shops. In education, convenient, accessible, on-demand, online learning model is different than the traditional classroom model.


* Disruptive innovation is not an automatic path to success, and success itself does not define a disruptive path. One has to accept failure as a possible outcome.


* Disruptive innovation is not the only way to maintain market share. Although those in higher education should be aware of trends and continue to evolve to stay relevant, their goal should be to maintain the market share they have by listening, meeting consumer needs, and building on those relationships. Engaging in new enterprises does not mean you ignore the current consumer base.



So how can you be a positive disruptor in your academic or clinical setting? Getting to the critical mass of faculty to tip the scales toward online education needs to be planned and persuasive. If it is easier, think of being a transformational leader-after all, the characteristics are similar, the ability to inspire through role-modeling and communication, encourage and challenge colleagues, and individualize opportunities for growth.15 "Transformational nurse leaders are able to identify the changes their environment needs, guide the change by inspiring followers, and create a sense of commitment to change."15([P]2)


Pearl16 identified steps to promote change leadership among physician leaders; however, the steps work regardless of discipline. Pearl outlined 5 steps that focus on components of a respectful relationship by focusing on the "vital organs" identified as appealing to the person's heart (aspirational vision), brain (provide the "why" and data to support and measure the change), and the gut (building a relationship to build trust).([P]7-17) Pearl lists the specific steps using an alphabetic mnemonic, A to E:[P]19


Create an Aspirational vision.


Clearly define the needed Behaviors.


Explain the Context for the changes required.


Provide timely, actionable Data.


Engage personally, genuinely.



Halstead's17 advice to nurse educators to expose nursing students to "faculty who are actively engaged as positive disrupters in leading change and innovation.[horizontal ellipsis]who embrace change and support others in introducing innovation in the curriculum"(p4) is a great strategy to ingrain the concept of positive disruption into nursing faculty (and nursing student) consciousness. This growing awareness will move nursing education forward and keep us relevant in this technological age.


Online learning and distance education is supported by leaders in academic and clinical nursing to educate nurses and to maintain certification and skills through continuing education. The American Association of Colleges of Nursing has provided leadership in the identifying standards and policies for distance education. The point of the Alliance for Nursing Accreditation Statement on Distance Education Policies18 was to ensure the maintenance of high quality in the delivery of nursing education, regardless of delivery method. "All nursing education programs delivered solely or in part through distance learning technologies must meet the same academic program and learning support standards and accreditation criteria as programs provided in face-to-face formats."(p1) The statement also included points related to the need for faculty development in distance education and technical support for both faculty and students. The American Association of Colleges of Nursing and other professional nursing and educational organizations provide resources to help faculty navigate and master the online environment.


There is a lot to learn about how to teach effectively online. However, there are many opportunities for the continued discussion of online learning pedagogy through conferences and webinars, as well as through online continuing education and resources for faculty. Mastery of the online environment requires knowledge, motivation, and a mindset of continuous improvement. Future columns will delve into innovative and evidence-based strategies for teaching and relationship-building with students in an online environment.




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