As I contemplate retiring in a few short months, it is time to say goodbye and turn this blog over to new writer(s). In many ways, one kind of goodbye has a lot in common with other goodbyes. There is the anticipation of the actual change, which begins the internal reorientation. William Bridges developed a model he called Transitions. Bridges pointed out that the positive and negative changes both had the internal process he named transition, which is the psychological reorientation that accompanies the external change. Transition is on a separate schedule from external change and shows how people vary in their responses. A common experience of change can lead to high variability in the pace of transitions.
Bridges authored a three-phase model. The first phase is Endings, which is concrete things that end but also symbolic things like one’s self-image, vision for the future, or things like habits and routines that will be disrupted. Many things that end are social, such as membership in a group, or proximity to certain people and relationships. Bridges describes the Neutral Zone as the wilderness between the Ending and the third stage, the New Beginning. In the Neutral Zone, things are disrupted and up in the air. This gives great room for creativity but for some it will be the stage that is most difficult to tolerate as there will be questions that cannot yet be answered, and some will find that to be anxiety producing. The New Beginning is perhaps the easiest stage as the psychological orientation settles and largely concludes.
Everett Rogers developed a model he called Diffusion of Innovation Theory. Rogers proposed five categories of response to innovation, to explain how ideas or products gain momentum and spread or diffuse through a specific population or social systems. Rogers was trained as a rural sociologist and conceptualized rural communities as the systems of study. Rural sociologists focused on the community-level phenomena, interpersonal networks and on the “boundedness of such social systems.” Using the bell-shaped curve of natural distribution, Rogers proposed 2.5 percent are Innovators, bringing new ideas or eager to test new ideas. Innovators are willing to take risks and operate from internal motivation.
The next group is 13.5 percent Early Adopters. Early Adopters are often opinion leaders who play leadership roles and embrace new ideas. This group has already established the need to change and will begin to focus on the pragmatic side of testing and implementation.
Inside the dome of the bell, are the Early Majority at 34 percent and the Late Majority also at 34 percent. The Early Majority are rarely leaders, but they do adopt new ideas before others. This group usually needs to see evidence before they adopt a new idea or product. The Late Majority are the skeptics who will only adopt a change after it has been tried by the majority and demonstrated success.
At the far end of the bell is the last group, the Laggards, who compose 16 percent of the population. This group is married to traditions, are risk averse, and skeptical of change. The Laggards can provide a useful lens that identifies what might go wrong with the change. This allows for prevention, early detection, and mitigation of risks.
Personally, I will face a massive transition, one of life’s larger changes. As the founding leader of the WA Rural Palliative Care Initiative, my role is ending, and I am adopting out the baby to new parents. For the initiative, it is perhaps time to assess the diffusion of palliative care ideas, skills and services within your team and the community. Each population segment will require different strategies. Cohort teams are the innovators and early adopters, so let’s focus on the strategies for the early and late majority as well as laggards.
It is not helpful to label laggards as resistant, or even the late Majority. It is functional to have some members of a group be skeptical, to hold on until the new change proves useful. The proving point is whether those members can voice proposed solutions to prevent or mitigate their concerns. Anyone who becomes mired in problem description and stalls there will drag down morale without being accountable to the group for constructive actions.
Innovators need very little other than room to test their ideas.
Early Adopters have accepted the need to change so do not need information that seeks to convince. Early Adopters prefer specific tools and performance indicators for implementations.
Early Majority will want success stories and evidence of effectiveness.
Late Majority-are influenced by others in the group and will want to know how many other people have tried the innovation and adopted it with the desired results.
Laggards will maintain skepticism the longest. Strategies for this group may include data, spelling out the consequences of not adopting the innovation, and pressure from those who have successfully adopted the change.
Rogers identified five main factors that influence adoption of an innovation.
- Relative Advantage - The degree to which an innovation is seen as better than the idea, program, or product it replaces.
- Compatibility - How consistent the innovation is with the values, experiences, and needs of the potential adopters.
- Complexity - How difficult the innovation is to understand and/or use.
- Triability - The extent to which the innovation can be tested or experimented with before a commitment to adopt is made.
- Observability - The extent to which the innovation provides tangible results.
Pat Justis, Washington State Department of Health