Healthcare Information

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How can others accept my new ideas? - Diffusion
of Innovations It is not enough to produce
satisfactory soap, it is also necessary to induce
people to wash Joseph Schumpeter, 1939
Clemens Steinböck, MBA Director for Quality
Initiatives AIDS Institute 212. 268 6108 -
cms18_at_health.state.ny.us
2
Ignaz Philipp Semmelweis
1846 - Assistant of First Obstetrical Clinic in
Vienna, Wiener Allgemeinen Krankenhaus, 27.
February 1846 1847 - Discovered that physicians
who were in contact with women who have childbed
fever infect others 1850 - Dr. Ignaz Philipp
Semmelweis, 15. May 1850, presentation before the
Imperial and Royal Society of Physicians of
Vienna 1861 - Dr. Ignaz Philipp Semmelweis, 1861,
Die Aetiologie, der Begriff und die Prophylaxis
des Kindbettfiebers (The Etiology, Concept, and
Prophylaxis of Childbed Fever) 1862 - Dr. Ignaz
Philipp Semmelweis, 1862, Offene Briefe
Ignaz Philipp Semmelweis, The Etiology, Concept,
and Prophylaxis of Childbed Fever, translated by
Codell Carter, University of Wisconsin Press, 1983
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Semmelweis July - October 1846
Gortvay, Zoltau Semmelweis, S. Hirzel Verlag,
Leipzig, 1976 Georg Sillo-Seidl Die Wahrheit
über Semmelweis, Aviston Verlag Genf, 1978
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Semmelweis July - October 1846
1789-1822 Professor Lucas Johann Boer 1822-1846
Professor Johann Klein
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Semmelweis March 1847
Starting today, every physician and student has
to wash their hands before entering the clinics.
No exeptions. I.P. Semmelweis May 15th, 1847
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Semmelweis March 1847 - March 1849
Mortality Rate, 1847-1848
14
12
10
8
6
4
2
0
June
July
April
March
March
August
January
October
February
December
September
November
7
Mortality Rates in Austria 1960-1995
Mortality Rate for Newly Mothers
0.090
0.080
0.070
0.060
0.050
0.040
0.030
0.020
0.010
0.000
1960
1965
1970
1975
1980
1985
1990
1995
Gesundheitswesen in Österreich Volkswirtschaftlich
e Verlags-Gesellschaft MBH, Wien, Österreich
(gratis)
8
Dr. Barry Marshall
1979 Dr. Robin Warren, Pathologist at the Royal
Perth Hospital, Australia found bacteria in
stomachs of patients 1981 Dr. Barry Marshall
starts his residency program 1982 Marshall
cultivates Helicobacter pylori, found in 100 in
Duodenal Ulcer and 77 in Gastric Ulcer 1984
first publication in Lancet finds cure with
common antibiotics and aspirin 1994 National
Institute of Health recommends treatment of ulcer
as outlined by Dr. Marshall
9
Controlling Scurvy

• 1497 Vasco de Gamas trip around the Cape of Good
  Hope, 100 out of 160 crew members tied of scurvy
• 1601 Captain James Lancester experimented with
  lemon juice to prevent scurvy
• 1747 James Lind, another experiment on HMS
  Salisbury
• 1795 British Navy adopts innovative prevention on
  all ships
• 1865 prevention was adopted for merchant marine

The Surgeon's Mate was first published in 1617.
Volume 1639 describes the treatment and
prevention of scurvy.
10
Lessons Learned

• Two parts of an innovation a) generate
  innovation and b) spread innovation
• Each innovation has a rate of diffusion (even
  successful innovations need time to spread)
• - how can we accelerate the rate of diffussion
• Each innovation had to be proven several times to
  be accepted
• - how can innovations be accepted without be
  tested again and again
• Each innovation was faced with resistance
• - how can overcome resistance is part of
  spreading innovation

11

• Diffusion of Innovations
• by Rogers, Everett
• The Free Press, New York, 1995

12
Diffusion of Innovations by E. Rogers

• Diffusion process by which an innovation is
  communicated over time among members of a social
  system
• Innovation idea, object, product
• Communication planned or spontaneous
• Social System society, organization, group

13
Factors for Diffusion - Why are people accepting
innovations?

• Relative Advantage innovation is perceived as
  better as then the idea it supercedes, prestige,
  convenience, economic and satisfaction
• Compatibilityinnovation is perceived as being
  consistent with existing values and past
  experience 'relevant to people'
• Complexity perceived difficulty to understand
  the use, 'reduction of complexity'
• Trialabilityinnovation can be experienced on a
  limited basis small scale test
• Observability results of innovations are
  visible to others

14
Diffusion of Innovation

• Innovators - Venturesome
• Early Adopters - Respect
• Early Majority - Deliberate
• Late Majority - Skeptical
• Laggards - Traditional

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Types of Innovators

• Innovators - VenturesomeNew ideas are outside
  the local circle of peers, bring outside ideas
  into local system clique of innovators are
  common even so geographically apart, tolerate
  risk, strong financial resources, willing to
  accept losses, maybe not be accepted by local
  society
• Early Adopters - Respectintegrated into local
  social system, are most opinion leaders, other
  look for advice from them - role model, decreases
  uncertainty about new ideas for others, offer
  subjective evaluation of innovation, less
  cosmopolite than innovators
• Early Majority - Deliberatejust before average
  accepts innovations, interact frequently with
  peers, rarely opinion leaders, deliberate before
  implementation, not leaders
• Late Majority - Skepticaladoption is now
  economic pressure or from peers, will adopt only
  if local majority has done so, financial less
  capable
• Laggards - Traditionalvery local, reference is
  the past, peers with similar traditional ideas,
  awareness of innovation late

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Other Issues

• Critical Mass
• Re-Invention
• Change Agent

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Rules of Diffusion (by Donald Berwick)

• identify changes that are ready to spread
• find innovators and support them
• invest in early adopters and allow communication
  with innovators
• make early adopters observable
• allow re-invent innovation
• trust and enable innovation

18

• The Tipping Point How Little Things Can Make a
  Big Difference
• by Malcolm Gladwell