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Step 1: Leadership

Identify a clinical champion who practices in the clinical setting.

Rationale:

The recommendation that any decision support implementation project begin with a clinical champion (innovator) is based on research about how successful innovation occurs. The success of any such efforts is based in part on the messenger and how the message is communicated to peers. Rogers, in Diffusion of Innovation¹, identifies four key components in successful innovation: "(1) an innovation (2) is communicated through certain channels (3) over time (4) among the members of a social system." The process of adopting innovations "is a very social process that involves interpersonal communication relationships," and the most successful communication relationships are between people who "share common meanings...a mutual language...personal and social characteristics," among whom "the communication of new ideas is likely to have greater effects in terms of knowledge gain, attitude formation and change, and overt behavior change." Similarly, Kotter² identifies the creation of "a sufficiently powerful guiding coalition," in which "the head of the organization is an active supporter" as an essential step in organizational change.

It is as important to work from the bottom up (clinical champion within the target setting) as it is to work through top down mechanisms (obtain an endorsement of the vision from key thought leaders). In settings where buy-in of participants, or lack thereof, can make or break the success of the innovation, mandates from above will be less successful than support from above and enthusiasm within the ranks.

¹ Rogers EM. Diffusion of Innovations, 5th Edition. Free Press, New York, 2003.
² Kotter JP. Leading Change. Harvard Business School Press. Boston, MA, 1996.

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