Diffusion of innovations in service organizations: Systematic review and recommendations

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization?

It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way).

This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.

Material prepared for conference session at the 2017 American Evaluation Association conference How can we support people to put their learning about new evaluation methods and innovations into practice? Led by Patricia Rogers and Jane Davidson Sat, Nov 11, 2017 (11:15 AM - 12:00 PM) Thurgood Marshall East, Washington Marriott Wardman Park.

The Innovation

  • Relative  advantage
  • Compatability
  • Low complexity
  • Trialability
  • Observability
  • Potential for reinvention
  • Fuzzy boundaries
  • Risk
  • Task issues
  • Nature of knowledge acquired (tacit/explicit)
  • Technical support

Communication and influence

  • From diffusion (informal, unplanned) to dissemination (formal, planned)
  • Social networks
  • Homophily
  • Peer opinion
  • Marketing
  • Expert opinion
  • Champions
  • Boundary spanners
  • Change agents



Outer context

  • Sociopolitical climate
  • Incentives and mandates
  • Interorganizational norm-setting and networks
  • Environmental stability

System antecedents for innovation

  • Structure:
  • Size/maturity
  • Formalization
  • Differentiation
  • Decentralization
  • Slack resources
  • Absorptive capacity for new knowledge
  • Pre-existing knowledge/skills base
  • Ability to find, interpret, recodify and integrate new knowledge
  • Enablement of knowledge sharing via internal and external networks
  • Receptive context for change
  • Leadership and vision
  • Good managerial relations
  • Risk-taking climate
  • Clear goals and priorities
  • High-quality data capture

System readiness for innovation

  • Tension for change
  • Innovation-system fit
  • Power balances (supporters vs opponents)
  • Assessment of implications
  • Dedicated time/resources
  • Monitoring and feedback


  • Design Stage
  • Shared meanings and mission
  • Effective knowledge transfer
  • User involvement in specification
  • Capture of user-led innovation
  • Implementation stage
  • Communication and information
  • User orientation
  • Product augmentation eg technical help
  • Project management support


  • Needs
  • Motivation
  • Values and goals
  • Skills
  • Learning style
  • Social networks


  • Complex, non-linear process
  • “Soft periphery” elements

Implementation process

  • Decision making devolved to frontline teams
  • Hands-on approach by leaders and managers
  • Human resource issues, especially training
  • Dedicated resources
  • Internal communication
  • External collaboration
  • Reinvention/development
  • Feedback on progress


Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. The Milbank Quarterly82(4), 581–629. http://doi.org/10.1111/j.0887-378X.2004.00325.x

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