The Adoption Cycle of Innovation
We cannot assume that innovations diffuse just because they are inherently valuable or fashionable. Instead, they diffuse because of the interplay of these factors. Early adopters take a risk of failure because they seek to build status by becoming an exemplary user. These adopters reduce uncertainty for other users by sharing their experiences and stressing the benefits of the technology, leading to continued adoptions. Coercive pressures by patients and other users then induce more widespread adoption.
Bocconi professors Amelia Compagni and Valentina Mele report this conclusion in an article written together with Davide Ravasi (Cass Business School): How Early Implementations Influence Later Adoptions of Innovation: Social Positioning and Skill Reproduction in the Diffusion of Robotic Surgery (forthcoming in the Academy of Management Journal, published online before print, doi: 10.5465/amj.2011.1184). This article is based on qualitative research on the diffusion of robotic surgery throughout Italy, which was widely adopted even though the technology was expensive, difficult to implement, and no tangible evidence existed that it had any benefits.
The authors conducted 191 interviews, corresponding to 1116 pages of transcripts, studied 425 newspaper and scientific articles relating to the implementation of the technology, read hospital related documents, and viewed 105 videos online. Based on this very extensive work, the authors first constructed a chronology of the diffusion of robot surgery, including all milestone events, and subsequently reconstructed organizational-level adoptions and implementations in light of that timeline. Then, they investigated how hospitals' motivation to adopt varied over the history of diffusion, and established the social position of the hospitals. Lastly, they also interviewed non-adopters to investigate their reasons not to adopt.
From this analysis, they found that early adopters implemented the technology because it was in line with their organizational culture of openness, or to build status as exemplary users. Initial implementations were likely to fail, and many hospitals abandoned the technology. However, those hospitals seeking to establish status continued to experiment with the technology, and actively disseminated their learning, stressing the technology's benefits. This reduced risks of implementation, and other peripheral hospitals continued to adopt in the hope of increasing their status, still with mixed success. However, at a certain point the media started reporting positively on the technology, and patients accepted only robotic surgery, and at this point many hospitals felt they had to adopt to remain competitive and legitimate.
This work has shown that currently held assumptions about the diffusion of innovations are incomplete. They do not disperse simply due to their inherent value, legitimacy, or fashionableness, but these pressures occur at different stages in the adoption cycle, and are different for different types of users. For managers who have to market a product with uncertain benefits, this study points to the key role of peripheral users that have much to gain from a successful adoption, and might take high risks in order to be the first to do so.
This research project has produced also the article Governing through Evidence: A Study of Technological Innovation in Health Care by Valentina Mele, Amelia Compagni, and Marianna Cavazza, in press in the Journal of Public Administration Research and Theory.