Promoting and Embedding Innovation

Diffusion
Following adoption, diffusion is the process of
adaptation required to accommodate the new
product or practice within the particular
healthcare environment (Berwick, 2003).
Innovations that are successfully diffused will
inevitably mutate so as to fit with context.
Although from the perspective of orthodox
evidence-based medicine this may constitute
dilution or deviation, adaptation is welcomed
by those who consider healthcare systems to
be complex and varied and therefore not
suited to simplistic solutions (Berwick, 2003).
It is also important to avoid inappropriate
diffusion – for example through the
introduction of costly and/or ineffective
practices (Rye & Kimberly, 2007).
Routinisation
Routinisation requires the innovation to be
made sustainable and can be defined as the
process through which innovations are
maintained for an appropriate period
(Greenhalgh et al, 2004). This requires new
ways of working to become embedded into
practice, performance management regimes
and cultural norms – in other words to become
part of the corporate culture (Buchanan et al,
2005). The likelihood is that „sustainability‟ will
manifest itself as „succession‟ or „adaptation‟
as the innovation mutates and gels with the
organisational environment.
Substitution
In a service which is continually innovating,
diffusion and routinisation cannot be
considered the sole end-points. Equally
important is the process of identifying products
and practices that should either be
discontinued or replaced. However, this is an
area of activity which is invariably overlooked
in both policy and research (Williams &
Dickinson, 2008).
9 Learning from experience