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abstract Aspects of the research and practice paradigm known as the diffusion of innovations are applicable to the complex context of health care, for both explanatory and interventionist purposes. This article answers the question, "What is diffusion?" by identifying the parameters of diffusion processes: what they are, how they operate, and why worthy innovations in health care do not spread more rapidly. We clarify how the diffusion of innovations is related to processes of dissemination and implementation, sustainability, improvement activity, and scale-up, and we suggest the diffusion principles that can be readily used in the design of interventions.
In synthesizing many studies from different disciplines about how people respond to new ideas, Everett Rogers was answering a call set forth by the sociologist Robert K. Merton: theorize, but in empirical ways and with practical implications.1 Now, fifty-six years past the first publication of Rogers's book Diffusion of Innovations, we briefly review this theory, its principles, and the implications for practice as a fifteen-year update to the book's last edition in 2003.
One of the best documented if frustrating principles of diffusion is that it can take a long time. Consider the case of Project ECHO (Extension for Community Healthcare Outcomes), previously reported in Health Affairs.2 This innovation in how academic medical centers partner with rural primary care clinicians to extend specialty care began at one site in New Mexico in 2003. By November 2017 Project ECHO reported 158 sites across the US, with sixty more sites in twenty-four other countries.3 The program has moved from hepatitis C care to include HIV/AIDS, geriatrics, psychiatric medication management, and more.4 Or consider the Green House model of nursing home care, in which "house-like" facilities are built that emphasize an open kitchen, residents' control in decision making, and empowered nursing assistants.5 Underwritten by a series of developmental, demonstration, and evaluation grants from the Robert Wood Johnson Foundation beginning in 2003, more than 200 Green Houses were in operation across the US in 2017 with 300 expectedby the end of 2018.6
Project ECHO and the Green House model are evidence-based innovations that are spreading as new ways to deliver health care, but have they diffused? To assess the diffusion of an innovation, one must attend to its denominator. In...