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

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