Identify the Characteristics of Potential Adopters

Many players are involved in the process of introducing a best practice or set of practices.

  • Beneficiaries will benefit from a new service or product.
  • Health service providers will implement the new practice or set of practices.
  • Managers and leaders within and outside the organization will provide the necessary support for implementation.
  • Policy makers provide highly valuable support for scale-up efforts.

Examining the characteristics of these different potential adopters can be quite useful in shedding light on how they can influence the rate and success of adoption. The general population can be divided up into five groups according to their willingness to adopt innovations (Figure 2).

Figure 2. Willingness to adopt

The innovators, only 2.5 percent of the population, are risk takers or risk tolerant. They like to try new things and can be seen as strange or reckless.

Early adopters are a larger group at 13.5 percent of the population. Early adopters are well-known opinion leaders. Because of their leadership, early adopters command attention and respect, and they function as cross-pollinators. Like bees fertilize flowers by bringing pollen from one flower to another, early adopters spread new ideas from innovators to others.

The early majority, 34 percent of the population, learn from others and are somewhat more risk averse than innovators and early adopters. Members of the early majority observe and then follow the early adopters.

The late majority, also 34 percent of the population, adopt an innovation once it has become the status quo or a standard of practice in the community. They need proof before accepting an innovation.

Laggards, or traditionalists, represent 16 percent of the population. While change agents should strive to understand and address their concerns, they should not be fixated on convincing laggards to adopt the innovation.

Any change coordination team should develop a strategy that involves different actors in the process of implementing the best practice or set of practices. The strategy must include ways to reach the different types of people who typically work in an organization.

Mobilize Opinion Leaders

Begin by bringing on board the opinion leaders—the adventurous innovators who spearhead new practices—and the early adopters, who are not far behind. These supporters are quick to envision how a new practice will help them reach their goals.

Encourage Others to Follow

Encourage the opinion leaders to mobilize the majority of staff—the early and late majorities—to understand and adopt the new practice or set of practices. This majority will need to understand how this practice or practices will address important organizational challenges that affect their work, how their acceptance is linked to their own standing within the organization, and how the practice will help them improve client care. In other words, they need to understand “what’s in it for them.”

Address Slow Changers Indirectly

Finally, studies on the diffusion of innovations show that a small percentage of almost any group lags behind in making the change. Do not focus your efforts on this small group of traditionalists, or laggards, but let the improved results eventually pull this group forward. When the change in practice becomes official, changes in expected standards and performance will motivate slow changers to adopt the new practice.

Address People's Reactions to Change

As word about the proposed change spreads, not everyone will immediately perceive its benefits or commit to supporting it. Change has been likened to a trapeze act: Author Marilyn Ferguson once said, “It’s not so much that we’re afraid of change or so in love with the old ways, but it’s that place in between that we fear… It’s like being between two trapezes." This is especially true if the change involves risk.

A successful change agent recognizes how different individuals are likely to react to the change and take this into account when planning and implementing the new practice. A staff member’s reaction will depend, in part, on how much he or she believes the change will affect his or her job or status. Some people initially respond to change by denying and resisting it. Under effective leadership, most people are willing to explore the change and its implications, and, ultimately, accept and commit to the change. Effective change agents understand these stages, recognize where people are in accepting change and know how to help them move from denial to commitment.

Figure 3 summarizes typical reactions to change and offers productive responses to people’s fears and concerns to help them move forward in the change process.

Figure 3. Dealing with individual responses to change

Source: Leading Change. The Manager. Management Sciences for Health, 2005.

Denial:  Initially, some people are uncomfortable giving up what is familiar. They might deny that the change will happen and hope they can continue operating as they always have. To address denial, provide clear information. State unmistakably when and how the change will take place, and offer coping mechanisms.

Resistance: Some people resist change by questioning whether it will succeed, wondering about their ability to cope and worrying about their job security. Create opportunities for staff members to express their anxiety, and listen attentively to their concerns. Resist the impulse to defend the change. Instead, show compassion and respect for people's feelings of loss and worry. A stakeholder analysis can help you understand existing incentives that might cause resistance to the change and inform the creation of coalitions that will support the change. These exercises will reveal supportive individuals who can approach likely resisters and persuade these resisters to join them.

Exploration:  Having had the opportunity to express concerns, people will be more likely to explore the possibilities that the changes could bring to their work, even if they are still apprehensive about how they will be personally affected. A change agent should provide opportunities and resources for discovering what is possible. At this stage, involve your staff in planning for the new practice: establishing priorities, setting short-term goals and offering training. Encourage people to prepare themselves in teams and to support one another.

Commitment: When people recognize and understand the benefits of the new practice for their client services, for the organization, and for themselves, they commit to the change. They accept the new practice, are ready to comply with its requirements, and commit themselves to carrying it out. You no longer need to “manage” the change process, for if you validate and reward their commitment, people will manage themselves. Set long-term goals, provide whatever support is needed and then get out of the way.