Factors that Affect Rate of Innovation Decision Making in O & P

Loosely defined, an Innovation is any idea, practice, or technology that is perceived as new or novel. A Technology is any design or process that aids in the cause-effect relationship to achieve a desired outcome. Innovations are adopted at different rates based largely on their sense of Risk or Advantage. This rate of adoption within a group of individual is known as Diffusion of Innovation. It is the process by which a new innovation is communicated within a group. The diffusion process involves: Knowledge of the new innovation, Persuasion from a trusted person or reference, Decision of acceptance or rejection, Implementation within the immediate context, and Confirmation that evaluates success and abandons or confirms use. Can you think of new innovations you saw adopted in the profession like TPE Liners, Microprocessor Knees, Externally Powered Upper Limb Devices, 3D Printing or processes like Electronic Billing, Paperless Office systems, CAD modification? Conversely, why was some technology rejected or abandoned like pressurized casting chambers, heated carbon pylon alignment, sand foot casting system, pneumatic "muscle"actuators, Multi-carbon spring feet, fabric-matrix custome silicone liner and others.

The Orthotic and Prosthetic profession is a very small profession with only 2.2 Degrees of Separation for 90% of the population according to the Watts-Stogatz formula. That means with less than 3 people from O & P with approximately 50 different contacts, most all of the profession is known personally. The power of these personal relationships for new technology is extremely high compared to other professions. This greatly influences (or inhibits) the degree to which new decisions are adopted or rejected in O & P.

The Rate of Decision making is influenced by 5 major factors. Relative Advantage or the differentiated ability the innovation promises. Compatibility of the innovation with the context of the usage. The Complexity of the technology compared to current systems and the ability to learn. Trialability, or the ability to try out a design first to test it first. And finally, Observability the consistent successful outcomes.

What is interesting is that the different groups of Innovators, Early Adopters, Early Majority, Late Majority, and Laggards have differing set of values, sense of risk, and desire for differentiation. Innovators are the smallest group at 2.5%. They are daring and take higher risks, and could be considered a bit rash. They routinely use components that do not have L-codes and constantly buying new fixtures or investing in largely unproven technology. This group may have eliminated plaster completely, but now can't offer certain orthotic products because the didn't consider what they can or cannot carve. Maybe they are looking to "jailbreak" their microprocessor devices for better function….even if it voids the warranty!

Early Adopters, at 13.5%, have less risk tolerance and pick which new ideas have greatest advantage. They are more socially integrated and "people in the know" who advocate or warn the rest of the group. They may use miscellaneous codes, but follow the guidelines of the manufacturer. They may be using 3D printing in certain cases, but it certainly would not be the majority of cases. They may ask the innovators what they are doing and try out a more acceptable form of advancement by mixing different upper limb components, but checking first to make sure they work. Although it is still being studied, there may be a bit a of a chasm between Innovators/Early Adopters because they share a more optimistic and positive attitude toward innovation. This may mean that this 16% of leadership may have different opinions from the rest of the group and "run away" from a majority of the population.

Early Majority, at 34% represent the first wave of greater acceptance. They are looking to the Early Adopters for guidance. They are deliberate, but not the last to try something new. They want assurance in writing that it will work and are upset if there is some added configuration or assembly. The Late majority, at 34%, are more skeptical and not the first to try new innovations. They may be more by pressure to "keep up" than by the need to integrate new things. They want someone else to construct the device and at times "black box" new things because they want someone else to be responsible for it if it does not work.

The Laggards, at 16%, are traditionalists that may choose to never adopt. In some aspects they are "reverse innovators" who do not go along with the crowd, but may choose not to adopt new things to their disadvantage. They believe that myoelectric and microprocessors devices are really not needed and we did just fine with body power and mechanical systems. They also retain knowledge of creating an interface out of leather and foam rubber….and frankly feel that was better! The question is which are you? Often in our our professional, personal, financial, social, or political lives, we are innovators, but in an other aspects may even be laggards!

This reveals a bit a "pro-innovation bias." Not all innovations are worth adopting and choosing the wrong ones can result in financial hardship. The most successful people are able to critically consider and consistently make better decisions to achieve desired outcomes. There is even a thing called "Shadow Innovation" that is the proliferation of negative innovations such as mail order orthotic-prosthetic devices, illegal billing, or Medicare fraud practices.

The thing is that we are all involved in the assessment of new ideas to adopt or reject them almost everyday. We make the decisions based on advantage, risk, economic benefit, increased efficiency, or decreased time commitment. We sometimes balance this with an expected loss of customization, technical proficiency, or process control to achieve the advantage. At times we, or even our patients, may decide the advantages simply do not outweigh the unanticipated negative results and we abandon the innovation. However, it is a continual inner discussion we must participate in to determine the pathway of our future.