Leading Changes in Practices to Improve Health

Change is not easy. Only a small percentage of efforts to change or scale up a practice meet expectations. Studies by John Kotter have shown that change efforts fail more often than they succeed. Effective change management, often termed diffusion of innovations, is a science that has been studied and documented by many people, including Donald Berwick and Everett Rogers.

One thing is clear: developing an effective process for change helps avoid the chronic mistake of underestimating what it takes to make change stick. Establishing a systematic approach to managing change is a critical factor for successfully adapting, implementing, scaling up and sustaining best practices.

In his book Diffusion of Innovations, Everett Rogers discusses a theory of effective change and describes how innovations are spread and how the process of change works. Rogers describes three main clusters of influence (Figure 1) that relate directly to the rate of adoption or diffusion:

                Figure 1. Clusters of Influence