SYSTEMS THEORY vs. DIFFUSION OF INNOVATION THEORY EVIDENCED-BASED PRACTICE

Systems theory and diffusion of innovation theory

Systems theory and healthcare delivery in the U.S.

According to theorist Ludwig von Bertalanffy, it is essential to view organisms -- both living and man-made -- as functional systems in a holistic sense to understand their true nature. This principle is manifested in the human body and also the organizations which provide healthcare. "A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent's actions changes the context for other agents. Examples include the immune system, a colony of termites, the financial market, and just about any collection of humans (for example, a family, a committee, or a primary healthcare team)" (Plsek & Greenhalgh 2001: 625).

Complex systems, such as the healthcare delivery system, have 'fuzzy' boundaries in the sense that different components may have ever-shifting duties, thanks to the needs of other organisms (the patient) and because of changes in the outside environment. For example, "not so long ago public health was the science of controlling infectious diseases by identifying the 'cause' (an alien organism)" such as a pathogens and containing the disease with vaccinations and hygienic precautions but now other epidemics (such as obesity and diabetes) have been shown to be "the result of the interplay of genetic predisposition, environmental context, and lifestyle choices" and demand different systemic responses (Plsek & Greenhalgh 2001:625). Systems theory stresses that the part is not equivalent to the whole and the 'whole' working system of healthcare delivery must be studied to address inadequacies of care.

Diffusion of innovation theory and the change process within healthcare delivery

Diffusion of innovation theory as coined by the theorist Everett Rogers suggests that innovations, almost like diseases, spread throughout the population, first beginning with 'carriers' who function as first adapters. The innovations then gradually diffuse into wider circles. Innovations are introduced through a five-stage process of knowledge; persuasion; decision; implementation and confirmation (Fitzgerald 2002 et al.: 1429). Within healthcare, where models of behavior and best practices are often particularly entrenched, diffusion of new ideas can be a challenge. "The successful diffusion of new knowledge may be a prerequisite to changes in concrete practices. Such knowledge bases are particularly important in professionalized or knowledge-based organizations, including health care" (Fitzgerald 2002 et al.: 1429). While establishing that the science behind a shift in practice is essential, it is equally important to have "strong networks, communication and supportive human resource management" to encourage providers to actually alter their behavior (Fitzgerald 2002 et al.: 1429). Although healthcare practitioners are required to keep abreast of current developments in their field, even with the emphasis upon evidence-based medicine in recent years, there often is resistance in agreeing that evidence about changing a particular practice is confirmed and has attained the status of 'knowledge.' In practice, social context and custom can often be just as powerful on the extent to which meaningful changes are instated.

Relationship between systems theory and current nursing practice

Systems theory has heavily influenced nursing theory at almost every level: Imogene King's interacting systems theory is one example of how the influence of systems theory has translated into a nursing-specific context. King's theory divides the nursing process and its view of the patient into a multi-component division of systems, all of which interact "constantly and intricately" with one another. Even if the systems are defined separately for theoretical and analytical purposes, all systems are symbiotic. The personal realm "in which individuals take in and process information…relies on individual perception as the essential characteristic to allow understanding of self and others" (Shanta & Connolly 2013:174). In contrast, the interpersonal system is based upon the patient's relationship with others and "concentrates on interaction, communication, transaction, role, and stress" (Shanta & Connolly 2013:174). In the third system, the social system, the interactions occur on a group level and reflect common values, goals, shared interests and other...

Nursing would seem to be a discipline particularly friendly to the tenants of systems theory, given its stress upon treating the 'whole' person, including a patient's social and psychological needs, versus purely focusing upon patients as biological entities. Additionally, the concept of systems theory also views the nurse and his or her situation as part of the patient's system: there is a fluid give and take between patient and nurse in terms of learning and sharing vs. The nurse administering medicine to the patient in a purely directive fashion.
Relationship between diffusion of innovation theory and current nursing practice

Despite criticisms of the nursing profession as resistant to change, the president of the ICN (International Council of Nurses) stresses that dissemination of knowledge is critical to improve access to nursing care worldwide: "My watchword is access. My definition of access relates to many areas of nursing and health: access by all people to quality health services and to nursing services; access by nurses to appropriate education; and access by governments to nursing policy advice" (Bryant 2010:406). Improving access to healthcare is critically linked to the spread of knowledge both amongst nurses and patients as to what behaviors promote health rather than inhibit it. Diffusion of innovation must be a more conscious process in healthcare, given the tremendous logistical, institutional, and psychological barriers which exist to care, and first-movers in any new practice must be extremely persuasive role models for the full permeation of the new technology to occur.

Search strategies

When I typed 'systems theory healthcare' into Google Scholar, I easily found an article relating systems theory to healthcare delivery as my first search term. When I typed 'systems theory' nursing into the CINAL search box, I similarly retrieved an article with ease, given the predominance of systems theory in a number of nursing theories. When I typed 'diffusion of innovation theory healthcare' into Google Scholar, I was directed to an article which I then had to access using my institution's log-in. Similarly, after finding an article on 'diffusion of innovation theory nursing' in CINAL, I initially received no results, but when I typed in 'nursing diffusion innovation,' I was able to find a suitable article.

References

Bryant, R. (2010). Extending the reach of nursing knowledge and innovation. Nursing and Health Policy Perspectives. International Nursing Review, 57(4), 406.

Retrieved from CINAL at doi:10.1111/j.1466-7657.2010.00864.x

This article is a statement by the president of the ICN (International Council of Nurses) on the need to improve the dissemination of healthcare, new knowledge, and technology to underserved populations. Diffusion of innovation theory stresses the processes by which innovations are disseminated. This statement discusses how developments in research studies are eventually disseminated to everyday practiced in the developed world. Then, they disseminate through various channels of care and education to the developing world.

Fitzgerald, L. (2002 et al.). Interlocking interactions, the diffusion of innovations in health care.

Human Relations 55(12) 1429-1449. Retrieved from Google Scholar:

doi: 10.1177/001872602128782213

This article first gives an overview of diffusion of innovation theory and then specifically applies the theory to a healthcare context. It discusses change resistance and inconsistent adaptation of evidence-based medicine. Often, the diffusion of a new innovation is stymied and the diffusion of innovation model in practice does not necessarily seamlessly unfold. Both emotionally and logically persuasive techniques must be deployed.

Plsek, P & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313):

625 -- 628. Retrieved from Google Scholar:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121189/

This article suggests that the modern healthcare environment is becoming an increasingly complex 'system' given the multiplicity of lifestyle conditions healthcare practitioners are faced with: contrary to older epidemics, chronic conditions do not necessarily have a clear root cause. Viewing healthcare delivery as a system is essential, given that it must be organic and evolving to deal with shifts in the environment.

Shanta, L.L., & Connolly, M. (2013). Using King's…