1. Humphrey, Carolyn J. MS, RN, FAAN

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Thankfully, evidence-based practice has made it to home care!! The emphasis on patient outcomes, cost, and the upcoming Medicare Pay for Performance reimbursement model has forced everyone to learn more about integrating evidence-based innovations in our organizations and into clinical practice. But disseminating the knowledge and having it adopted can be a slow process.


Dr. Donald Berwick's JAMA article, "Disseminating Innovations in Health Care," provides an insightful examination of the reasons disseminations of healthcare innovations go slowly and how leaders can accelerate the process. I find Dr. Berwick's discussion of the "characteristics of the people who adopt the innovation, or fail to do so" most interesting. It describes how individuals and leaders work together to effect change. The percentages listed below are the numbers of individuals found in each group. See which of these categories "fits" your approach to new ideas and change.


* Innovators-2.5%. They are venturesome, tolerant of risk, fascinated with novelty, and willing to leave the village to learn. They belong to cliques that transcend geographical boundaries and invest energy in those remote connections. Often thought of as weird or mavericks, they may appear heavily invested in a topic.


* Early Adopters-13.5%. Opinion leaders, locally well connected, they network with innovators and other early adopters. Others watch them and often choose them as elected leaders or representatives of clinical groups.


* Early Majority-34%. They learn mainly from people they know well, relying on personal familiarity more than science or theory before they decide to test a change. They are more risk-averse than early adopters.


* Late Majority-34%. They look to the early majority for signals of what is safe to try. They don't find remote, cosmopolitan sources of knowledge to be either trustworthy or particularly interesting. They will adopt an innovation only when it is obvious it's the status quo, i.e., a new approach to clinical practice, not before.


* Laggard-16%. Those whose point of reference is in the past, often making choices that are wise because they swear by the tried and true. Just as often they may be obstructionists to valid change. In a regulatory environment, these individuals eventually have to change, although they may not ever like it!!



Examining these categories can assist in addressing the differences that exist to ensure positive, well-thought-out changes. These terms also can be used to describe an organization's characteristics in disseminating change. Thinking about the evolution of OASIS, I can recall working with people and organizations that fit into each of these categories.


Consider these traits as you move changes such as integrating evidence-based practice forward.




Berwick, D. M. (2003). Disseminating innovations in health care. Journal of the American Medical Association, 289 (15), 1969-1975.