This paper begins with a search of two different databases: Google Scholar and CINAL. A search on 'systems theory' and 'diffusion of innovation theory' was conducted using both search engines. Then the paper compares and contrasts both theories in light of their impact upon healthcare delivery in the United States and how both theories have influenced nursing practice using the articles found in the initial search.
SYSTEMS THEORY vs. DIFFUSION OF INNOVATION THEORY
EVIDENCED-BASED PRACTICE
Systems theory and diffusion of innovation theory
Systems theory and healthcare delivery in the U.S.
According to theorist Ludwig von Bertalanffy, it is essential to view organisms -- both living and man-made -- as functional systems in a holistic sense to understand their true nature. This principle is manifested in the human body and also the organizations which provide healthcare. "A complex adaptive system is a collection of individual agents with freedom to act in ways that are not always totally predictable, and whose actions are interconnected so that one agent's actions changes the context for other agents. Examples include the immune system, a colony of termites, the financial market, and just about any collection of humans (for example, a family, a committee, or a primary healthcare team)" (Plsek & Greenhalgh 2001: 625).
Complex systems, such as the healthcare delivery system, have 'fuzzy' boundaries in the sense that different components may have ever-shifting duties, thanks to the needs of other organisms (the patient) and because of changes in the outside environment. For example, "not so long ago public health was the science of controlling infectious diseases by identifying the 'cause' (an alien organism)" such as a pathogens and containing the disease with vaccinations and hygienic precautions but now other epidemics (such as obesity and diabetes) have been shown to be "the result of the interplay of genetic predisposition, environmental context, and lifestyle choices" and demand different systemic responses (Plsek & Greenhalgh 2001:625). Systems theory stresses that the part is not equivalent to the whole and the 'whole' working system of healthcare delivery must be studied to address inadequacies of care.
Diffusion of innovation theory and the change process within healthcare delivery
Diffusion of innovation theory as coined by the theorist Everett Rogers suggests that innovations, almost like diseases, spread throughout the population, first beginning with 'carriers' who function as first adapters. The innovations then gradually diffuse into wider circles. Innovations are introduced through a five-stage process of knowledge; persuasion; decision; implementation and confirmation (Fitzgerald 2002 et al.: 1429). Within healthcare, where models of behavior and best practices are often particularly entrenched, diffusion of new ideas can be a challenge. "The successful diffusion of new knowledge may be a prerequisite to changes in concrete practices. Such knowledge bases are particularly important in professionalized or knowledge-based organizations, including health care" (Fitzgerald 2002 et al.: 1429). While establishing that the science behind a shift in practice is essential, it is equally important to have "strong networks, communication and supportive human resource management" to encourage providers to actually alter their behavior (Fitzgerald 2002 et al.: 1429). Although healthcare practitioners are required to keep abreast of current developments in their field, even with the emphasis upon evidence-based medicine in recent years, there often is resistance in agreeing that evidence about changing a particular practice is confirmed and has attained the status of 'knowledge.' In practice, social context and custom can often be just as powerful on the extent to which meaningful changes are instated.
Relationship between systems theory and current nursing practice
Systems theory has heavily influenced nursing theory at almost every level: Imogene King's interacting systems theory is one example of how the influence of systems theory has translated into a nursing-specific context. King's theory divides the nursing process and its view of the patient into a multi-component division of systems, all of which interact "constantly and intricately" with one another. Even if the systems are defined separately for theoretical and analytical purposes, all systems are symbiotic. The personal realm "in which individuals take in and process information…relies on individual perception as the essential characteristic to allow understanding of self and others" (Shanta & Connolly 2013:174). In contrast, the interpersonal system is based upon the patient's relationship with others and "concentrates on interaction, communication, transaction, role, and stress" (Shanta & Connolly 2013:174). In the third system, the social system, the interactions occur on a group level and reflect common values, goals, shared interests and other commonalities on a social level (Shanta & Connolly 2013:174). Nursing would seem to be a discipline particularly friendly to the tenants of systems theory, given its stress upon treating the 'whole' person, including a patient's social and psychological needs, versus purely focusing upon patients as biological entities. Additionally, the concept of systems theory also views the nurse and his or her situation as part of the patient's system: there is a fluid give and take between patient and nurse in terms of learning and sharing vs. The nurse administering medicine to the patient in a purely directive fashion.
Relationship between diffusion of innovation theory and current nursing practice
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