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The Impact of System & Diffusion

Theories in Evidence Based Practice

Romaine L. Martin, D.Min, JD, MS, BSN
[June 7,2011]
A. Introduction
Nursing has made significant strides as a unique profession that is vital to the future of
health care delivery. These strides are attributed to the emergence of concepts derived from in-
depth investigation, compilation and application of scientific theory. The research of nurse
theorists largely contributed to this status for the intention of advancing nursing education and
practice. For the unity of purpose, theoretical models did not discredit but complement the art
and science of nursing (Jones, 2011). System theory and diffusion of innovation theory are
examples of scientific concepts that emerged to advance nursing practice and health care delivery
(Kitson, 2008; Blakeney, Carleton, & Coakley, 2009). Theory is germane to this essay in addition
to an explanation of the research conducted.

Evidenced based practice (EBP), is an essential principle in nursing education and

practice. Leading nursing organizations recommend evidence based practice in all aspects of
education and patient care services (Reavy & Tavernier, 2008). Schoenfeolder (2007) illustrates
EBP as dynamic and progressive to predict and influence the best patient outcomes. System
theory and diffusion of innovation is employed to bring to light the enormity of nursing as an
EBP for the advancement of health care delivery.
B. Systems Theory in Healthcare Delivery
Systems theory developed from historical ideas. In the early 1900’s, Ludwig von
Bertalanffy, a renowned philosopher and theoretical biologist, modernized the significance of
general systems theory (Drack et al., 2007). Von Bertalanffy formalized biological and
mathematical concepts to demonstrate the validity of general systems theory (Bertalanffy, 1972).
The phenomenon functions to unlock conceptual thinking. The premise is all levels of an
organism, whether living or environmental, comprise a logical homology that should be studied
as an organized whole. For that reason, a study solely on the order of parts is isolated and
incomplete to fully determine the complexity of a problem. In health care delivery, system
theory influences patterns of care, policies and practices to influence change in the whole
organization (Bertalanffy, 1972).
The work of Batalden & Mohr (1997) serves to channel planning and decision making.
The study relied on system theory to emphasize the capability of information systems in health
care delivery in meeting changing patient demands and innovation. Similarly, Hatcher &

Heetebry (2004) uses system theory to give insight into technological factors and barriers in
health care delivery.

These researchers utilized systems theory to draw attention to best practices in healthcare
delivery. Case in point, technology is vital to health care delivery. Based on system theory,
technology should be studied as an organized whole to achieve greater efficiency. A narrow
approach will limit the potential impact of technology and, unintentionally, create additional
gaps and errors. Flaws will be inevitable and compromise the full extent of technology as a
whole system. Hence, the theory guided a holistic examination of technology. As shown in
Hatcher & Heetebry (2004), there are technological possibilities in health care delivery that
comprise patient management, simulation, imagery, remote medical diagnosis, mobile health
care, telemedicine, internet & intranet programming, security, distance learning, data mining and

C. Diffusion Theory and Healthcare Delivery

Another important theorist is Everett M. Rogers, a sociologist, who introduced diffusion

and innovation theory. Rogers’s theory is utilized to create change in health care delivery
(Sanson-Fisher, 2004). The premise is the necessity of 100% adoption of innovation for effective
and embedded change to occur (Robertson, 1967). The literature reveals diffusion theory as a
fundamental to change. Rogers stipulates the essentials of five distinct elements for effective
change; these are relative advantage, compatibility, complexity, trialability and observability
(Sanson-Fisher, 2004, p. S55). Diffusion theory is powerful; in addition to offering guidelines for
leading and entrenching change, the theory has the capacity to frame evidence & employ
findings (Leeman et al, 2006).

In addition to systems theory, Rogers’s diffusion of innovation theory is utilized to

advance technology in health care delivery. There is sufficient research to illustrate the
advantage of telehealth to improve health care access & costs (Walker & Whetton, 2002; Wang
et al, 2005). Nonetheless, traditional and conservative views of health care delivery remain a
barrier particular in highly structured institutions such as hospitals. For this reason, the
innovation of telehealth is minimized or disregarded and, regrettably, the opportunity for
improved patient outcomes is avoided or under developed (Walker & Whetton, 2002). The

power of Rogers’s theory as a change process has boosted innovation in the face of resistance.
According to Walker & Whetton, 2002, “innovation is more likely to be adopted if: perceived as
having a relative advantage over the method it supersedes and as being compatible with existing
values and needs” (p. S3:74).
D. Systems Theory and Nursing Practice
The benefits of systems theory in nursing practice are unmistakable. Concepts of
wholeness and openness are consistent with nursing principles. The basic idea of system theory
is an Aristotelian view that states, “The whole is more the sum of its parts” (Bertalanffy, 1972
p.407). Nurses employ the concept of wholeness in problem solving. For instance, system theory
evaluated the influence of family anxiety on patient recovery (Mitchell et al, 2003). The analysis
revealed the weight of family anxiety and uncertainty on patient clinical outcomes in the
intensive care unit (Mitchell et al, 2003). Hence, system theory illustrated the family as a key
component influence patient recovery.

The results evidenced best practices in achieving patient outcomes. Here, the relationship
between systems theory and EBP is suggested. As stated in Schoenfeolder (2007), “EBP is
defined as the integration of best research evidence with clinical expertise and patient values” (p.
7). Moreover, systems theory is invaluable for critical thinking and decision making. The theory
channels higher thinking to consider and balance the complexity of a problem. This is implied in
the literature review of Nelson (2011), who examines the circular and balancing affect of theory.
Likewise, Bertalanffy (1972) draws attention to a multiplicity of factors in system theory and not
the vacuity of insular thinking.

E. Diffusion Theory and Nursing Practice

Equally significant is diffusion of innovation theory for offering a systematic course of

action to elicit change. Contrary to system theory, diffusion theory maps a process to achieve
change. While system theory opens the boundaries of critical analysis, diffusion theory is
directive to entrench change, i.e. new behavior. Although both theories are relevant for health
care reform, diffusion theory fulfills the intention of change. Nurses, as change agent, will make
powerful accomplishments to innovate global health systems by undertaking diffusion theory
(Blakeney et al, 2009).

Too often, nurses predict and plan innovation that fail or the actual results are less
favorable. The articles provided insight on processes to strengthen approaches for improving
nursing education and practice. Without a doubt, the application of theory will lead to more
effective nurse leadership and change management to advance the quality of patient care. I
suspect that greater inclusion of Rogers’s five distinct elements for effective change will open
new opportunities for advanced nurse practice (Sanson-Fisher, 2004).


Batalden, P. B., & Mohr, J. J. (1997, Summer). Building knowledge of health care as a system.

Retrieved April 28, 2011, from Quality Management in Health Care:

lth_Care_as_a_System.1.aspx. This article follows a system approach to resdesign the

operation of health care delivery by presenting a 10 step process that builds knowledge of

organizational elements.

Bertalanffy, L. v. (1972, December). The history and status of general systems theory. Retrieved

April 24, 2011, from The Academy of Management Journal:

sici=0001-427328197212%2915%3A4%3C407%3ATHASOG%3E2.0CO%3B2-4. A

leading general system theorist presents historical views and clarifies philosophical

principles that are mathematically illustrated and applicable to biological, technological,

psychological, cultural and linguistical areas of interest.

Blakeney, B., Carleton, P., & Coakley, E. (2009, May 31). Unlocking the power of innovation.

Retrieved April 27, 2011, from Online Journal of Issues in Nursing: Principles of diffusion

theory are presented to illustrate the capability of nurses to innovate health care delivery.

Drack, M., Apfalter, W., & Pouvreau, D. (2007). On the making of a system theory of life: Paul

A Weiss and Ludwig Von Bertanlanffy's Conceptual. Q Rev Biol , 82 (4), 349-373. An

analysis of general system theory by comparing the influence of two major theorists who

are renaissance thinkers in system biology.

Hatcher, M., & Heetebry, I. (2004). Information technology in the future of health care. Journal

of Medical Systems , 28 (6), 673-687. The authors employ system theory to present a
comprehensive analysis of obtainable technological sources that should be considered to

innovate health care delivery.

Kitson, A. L. (2008). The need for systems change: reflections on knowledge translation.


of Advanced Nursing , 65 (1), 217-228. The article explores the proposition of knowledge

theory to effectively transfer new information into clinical practice by the integration of

systems theory and other models for the promotion of innovation in health care delivery.

Leeman, J., Jackson, B., & Sandelowski, M. (2006). An evaluation of how well research reports

facilitate the use of findings in practice. Journal of Clinical Scholarship , 38 (2), 171-177.

The author relies on Roger’s diffusion theory to examine the manner new clinical

interventions are adopted and purport the timeliness of implementation when research

findings have sufficiently evidenced the need to innovate.

Mitchell, M. L., Courtney, M., & Coyer, F. (2003). Understanding uncertainty and minimizing

families anxiety at the time of transfer from intensive care. Nursing and Health Sciences,

207-217. The authors employ general system theory as a framework to analyze data that

illustrates the significance of family coping conditions on the rate of patient recovery.

Nelson, N. W. (2011, January ). Questions about certainty and uncertainty in clinical practice.

American Speech-Language-Hearing Association , 42, pp. 81-87. The author analyzes the

Kamhi’s viewpoint on evidence based practice to support uncertainity as a useful process

to initiate and assure continuing innovation in the clinical setting.

Reavy, K., & Tavernier, S. (2008). Nurses reclaiming ownership of their practice:

Implementation of an evidence-based practice model and process. The Journal of

Continuing Education in Nursing , 39 (4), 166-172. The article supports the necessity of

evidence based focus in clinical nursing practice and describes implementation models

for greater utilization.

Robertson, T. S. (1967). The Process of Innovation and the Diffusion of Innovation. Journal of

Marketing , 31, 14-19. Innovation is examined from different theorectical perspectives

with emphasis on Roger’s diffusion theory to demonstrate the application of marketing

processes to influence the ultimate user in the midst of risks, opposition and competing


Sanson-Fisher, R. W. (2004, March 15). Diffusion of innovation theory for clinical change.

Retrieved April 19, 2011, from Medical Journal of Australia: The author

summarizes the five primary components of Roger’s theory to explain the process of

adoption and diffusion of innovation in evidence based practice.

Schoenfeolder, D. P. (2007, August). Simply the best: teach gerontological nursing students to

teach evidence-based practice. Journal of Gerontological Nursing , 6-11. This article

illustrates the instructional method used to introduce nursing students to evidence based

practice and, at the same time, functions to disseminate knowledge at the clinical setting.

Sitzman, K. L., & Eichelberger, L. W. (2011). Undertanding the work of nurse theorists.

Masschusetts: Jones and Barlett. The textbook is a comprehensive study of the leading

nurse theorists and the conceptual models that has shaped the future of nursing.

Walker, J., & Whetton, S. (2002). The diffusion of innovation: factors influencing the uptake of

telehealth. Journal of Telemedicine and Telecare , 3, 73-75. The article discusses the

advantages of telehealth in health care delivery and applies Roger’s diffusion theory to

promote its utilization.

Wang, B. B., Wan, T. T., Burke, D. E., Bazzoli, G. J., & Blossom, Y. J. (2005, January/March).

Factors influencing health information system adoption in American hospitals. Retrieved

April 26, 2011, from The conceptual

framework employed Roger’s diffusion theory is utilized to analyze the decision making

patterns and openness of different hospital systems to adopt innovation in health care