A Comparison of System and Diffusion Innovation Theory in Healthcare Delivery and Nursing Practice

Introduction

As the field of nursing as become increasingly evidence-based, theory has played an important role in the practice and delivery of healthcare services. Nursing theories vary in their scope, ranging from grand theories that pertain to general healthcare concepts to specific practice-related theories that relate to particular applied scenarios. The purpose of this paper is to compare two independent nursing theories and the implications for healthcare delivery. Specifically, this paper will compare and contrast systems theory and diffusion of innovation theory and their impact on healthcare within the U.S. The relationship between systems theory and healthcare delivery in the U.S. will first be explored followed by an exploration of diffusion innovation theory's impact on the change process in U.S. healthcare. Discussion will then focus on the relationship between these two theories and current nursing practice. A brief summary of the search strategies used for this paper will be included as well. This essay will conclude with a brief summary and outline of key points. 

Relationship between Systems Theory and Healthcare Delivery in the U.S.

Complex systems theory is a conceptual framework designed to explore how relationships existing in an interconnected network of parts function to achieve overarching goals (Clancy, Effken, & Pesut, 2008). Similar to the psychological principle of "Gestalt", complex systems theory emphasizes a holistic depiction of a particular network, suggesting that the whole is greater than the sum of its parts (Clancy, Effken, & Pesut, 2008). Complex systems theory provides an effective lens in which to examine the U.S. healthcare system, as this system represents one of the most complex and dynamic networks in the nation. Effective healthcare delivery is a result of the self-regulation and self-correction of multiple individual components (e.g., practice, policymaking, consumerism) that all contain both functional and structural relationships with other components (Jordon, Laham, Anderson & McDaniel, 2010). As evidenced by Jordon and colleagues (2010), healthcare organizations are complex adaptive systems that contain multiple non-linear relationships. The effective delivery of healthcare in the U.S. is a direct result of the perpetual learning, self-regulation and self-correction of these systems (Jordon et al., 2010). 

Relationship between Diffusion of Innovation Theory and the Change Process within Healthcare Delivery in the U.S.

Diffusion has become an increasingly cited concept within U.S. healthcare (Torre & Crowley, 2011). As healthcare is a field that depends heavily on innovation, the effective diffusion of this innovation is essential to the optimal delivery of healthcare services (Torre & Crowley, 2011). Interestingly, innovation may also result in unwanted or disrupted changes within a particular system (McGarry, Cashin & Fowler, 2011). According to Torre and Crowley (2011), the effective delivery of healthcare results in a balance between innovation, the diffusion of this innovation amongst relevant components of the healthcare system, and preventing unwanted or unnecessary disruptions in the status quo. As the fields of nursing and healthcare have become more evidence-based in recent years, the innovative process has increased substantially (McGarry, Cashin & Fowler, 2011). Therefore, healthcare has undergone tremendous changes at the systemic and organizational levels and practitioners have been forced to constantly adjust to these changes (McGarry, Cashin & Fowler, 2011). Diffusion of innovation theory suggests that innovation and change is adopted in a "S-curve" fashion, in which a range of critical dynamics function to facilitate change (Torre & Crowley, 2011). Whether or not change is adopted within the U.S. healthcare system is dependent on factors such as: relative advantage, the prevalence of homogenous groups, and compatibility with previous innovations (Torre & Crowley, 2011). While the networks that combine to facilitate change within the U.S. healthcare system are complex, diffusion of innovation theory offers an efficacious paradigm in which to examine the channels that regulate this change (Torre & Crowley, 2011). 

Relationship between Systems Theory and Current Nursing Practice

As with the healthcare system at large, complex systems theory provides numerous avenues in which to explore nursing practice. Nursing professionals currently find themselves intertwined within multiple systems (Jordon et al., 2010). The effective delivery of nursing care is dependent upon the successful navigation of systems such as professional networks, patients and their families, the community, and the healthcare system (Jordon et al., 2010). Furthermore, more effective change occurs when examined from the systemic level (Jordon et al., 2010). When one aspect of the nursing field adopts a particular innovation or change, it has the ability to impact all other components of that system (Clancy, Effken, & Pesut, 2008). Therefore, consideration of the potential impacts these changes can make amongst an entire complex system will help facilitate more effective service delivery than simply examining change at the individual component level (Clancy, Effken, & Pesut, 2008). According to Clancy, Effken and Pesut (2008), there are nine levels of complexity from which to explore how change can occur. The optimal self-regulation and systemic adaptation to change requires consideration of each of these levels (Clancy, Effken, & Pesut, 2008). By understanding how information is received, processed, and delivered within a system, nursing practitioners can greatly improve their abilities to meet patient needs and improve healthcare service delivery through healthcare information systems (Jordon et al., 2010). 

Relationship between Diffusion of Innovation and Current Nursing Practice

Similar to complex systems theory, the diffusion of innovation theory also has numerous applications to nursing practice. The concepts of this theory can be directly applied to primary care nursing, for example (McGarry, Cashin & Fowler, 2011). According to McGarry, Cashin and Fowler (2011), the diffusion process consists of five steps, including: building awareness for change; encouraging others to change; evaluating innovation; implementing the innovation; and confirming the innovative change. This process can be evidenced by numerous examples in primary care, such as the utilization of a novel medication or procedure (Torre & Crowley, 2011). Primary care environments often stagnate in their utilization of innovation, and consideration of this diffusion process, the type of adapters employed within the organization, factors related to the innovation, and rates and barriers related to the adoption of this innovation can all help determine the merit of some innovation on practice (Torre & Crowley, 2011).  

Summary of Search Strategies

Relevant studies were located using the Google Scholar and CINAHL search databases. The following search terms were used: diffusion of innovation; systems theory; nursing; and healthcare. A variety of modifiers and Boolean operators were used to expand or narrow the search as needed. Searches were limited to peer-reviewed studies in scholarly publications. As the initial search yielded more than 1,000 results in each database, the search was limited to studies published within the past five years. From this point, studies were selected based on their relevance to the topic of the current essay. 

Conclusion

The purpose of this essay was to consider how two theories of healthcare (i.e., diffusion of innovation and complex systems theory) applied to healthcare service delivery and current nursing practice. Relevant studies were located through Google Scholar and CINAHL databases, and the specific application of these theories to the modern healthcare environment were considered. Based on the evdience provided above, it is clear that effective healthcare and nursing practice is dependent on the successful integration of complex, interrelated systems, as well as the diffusion of innovation amongst these systems. 

Annotated Bibliography

Clancy, T. R., Effken, J. A. & Pesut, D. (2008). Applications of complex systems theory in nursing education, research, and practice. Nursing Outlook, 56(5), 248-256.

In this review article, authors considered the role of complex systems theory in various aspects of nursing and healthcare. According to these authors, the seemingly infinite number of systemic components within the healthcare system make the field a prime vehicle from which to apply complex systems theory. This study offers a comprehensive analysis of how the interconnected networks within the healthcare system function to accomplish larger organizational objectives. Furthermore, the perpetual technological and information changes experienced within the healthcare field warrant use of the complex systems theory. 

Jordon, M., Lanham, H. J., Anderson, R. A. & McDaniel, R. R. (2010). Implications of complex adaptive systems theory for interpreting research about health care organizations. Journal of Evaluation in Clinical Practice, 16(1), 228-231.

This review article summarized the potential applications of complex systems theories to the field of nursing. Specifically, these authors reflected on the implications of systems theory for research on healthcare organizations. Based on an extensive review of the literature, authors suggested that systems theory has the potential to vastly improve the interpretation of health care organization research. This study provides value to researchers and practitioners seeking to utilize an efficacious conceptual framework for exploring diverse agents within healthcare organizations and the processes and functions that exist within complex systems. 

McGarry, D., Cashin, A. & Fowler, C. (2011). "Coming ready or not" high fidelity human patient simulation in child and adolescent psychiatric nursing education: diffusion of innovation. Nurse Education Today, 31(7), 655-659.

In this paper, authors examined the role of diffusion of innovation theory in explaining innovation-related change in psychiatric nursing. Upon reviewing current literature related to specific innovation techniques within psychiatric nursing, these authors discovered that the diffusion of innovation model was an effective lens from which to gauge change within this nursing sub-discipline. However, the theory was limited in its predictive ability. This study highlights the importance of theoretical frameworks when analyzing healthcare change, particularly highlighting the applicability of diffusion of innovation theory. 

Torre, C. & Crowley, A. (2011). The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers. Policy, Politics, and Nursing Practice, 12(3), 141-149.

In this review, authors utilized diffusion of innovation theory to examine the interpretation of nursing regulatory policies in the New Jersey and Connecticut areas. Specifically, authors sought to examine how this theory helped explain and predict regulatory change related to the safe administration of medication to children. According to these authors, the diffusion of innovation theory helps describe the existing training and administrative needs related to medical prescribing. This study provides an effective application of diffusion of innovation theory and provides several possible policy-related and research directions  based on the existing diffusion process within these regions. 

References

Clancy, T. R., Effken, J. A. & Pesut, D. (2008). Applications of complex systems theory in nursing education, research, and practice. Nursing Outlook, 56(5), 248-256.

Jordon, M., Lanham, H. J., Anderson, R. A. & McDaniel, R. R. (2010). Implications of complex adaptive systems theory for interpreting research about health care organizations. Journal of Evaluation in Clinical Practice, 16(1), 228-231.

McGarry, D., Cashin, A. & Fowler, C. (2011). "Coming ready or not" high fidelity human patient simulation in child and adolescent psychiatric nursing education: diffusion of innovation. Nurse Education Today, 31(7), 655-659.

Torre, C. & Crowley, A. (2011). The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers. Policy, Politics, and Nursing Practice, 12(3), 141-149.