Guiding
assumptions.
Reviews of these literatures resulted in the identification of
several central assumptions which guide the research. First, organization-level
models of the adoption, implementation and assimilation of innovations
are more complex than individual models (Rogers, 1995; Klein &
Sorre, 1996; Van de Ven, Angle and Poole, 2000; Meyer and Goes,
1988). Second, scientific evidence in support of the effectiveness
of an innovation may be helpful but it is neither necessary nor
sufficient for the adoption of innovative practices by organizations
(Abrahamson, 1991; Denis et al., 2001). Third, effective approaches
for arriving at adoption decisions and implementing new practices
are commonly known by managers but are uncommonly practiced (e.g.,
Nutt, 1999). Fourth, variables that explain significant and meaningful
variability in the decision to adopt innovations and the success
of implementation efforts 1) span multiple levels from the innovation
itself to the environment in which adopting organizations conduct
business, and 2) include process, perceptual, and attitudinal
variables (e.g., Damanpour, 1991; Fishbein & Azjen, 1975 ;
Meyer and Goes, Rogers, Van de Ven, Angle, and Poole). Fifth,
systematic study of the factors and processes impacting adoption
decisions and implementation efforts is critical to maximizing
functional learning (e.g., self-correcting processes) and minimizing
superstitious learning (e.g., proliferation of self-serving explanations
of successful and unsuccessful implementation efforts) (Argyris,
1989; Senge, 1990). Finally, the innovation literature suggested
that it is important to examine two key phases of user-based innovation
processes: the adoption decision-making phase and the implementation
phase.
Research
models. Study hypotheses are linked to two fundamental models,
which in turn, are directly related to the two key phases of user
- based models of the innovation process (i.e., the adoption decision
phase; the implementation phase.) The phase one model, which focuses
on the adoption decision, conceptualizes the decision to adopt
as a decision made under conditions of risk. The phase two model,
which applies only to organizations that decide to adopt an innovation,
regresses the success of the innovation implementation effort
on variables which span several levels of analyses. As a result,
the phase two model is conceptualized as a hierarchical linear
model.
The
adoption decision is seen as a decision under risk because adopting
an innovation involves both costs (e.g., substantial start-up
costs) and benefits (e.g., reduced inpatient or other service
costs) to organizations and stakeholders (e.g., employees, consumers).
In addition, perceptions of costs and benefits typically vary
by stakeholder group (see Table 1 for hypothetical example) (Denis
et al, 2001).
Table
1. Cost/Benefit Map for Hypothetical Innovation
| Stakeholder |
Benefits |
Costs |
| Provider
organization |
Reduce
inpatient or other costs |
High
start-up costs; difficulty hiring staff |
| Direct
care staff |
More
effective service |
Inconvenient
hours; burnout |
| MIS
staff |
Increased
power for department |
Heavier
workload |
| Consumer |
Fewer
hospitalizations |
Less
freedom |
Research
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