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Invited Commentary
Less Is More
May 2015

On the Undiffusion of Established Practices

Author Affiliations
  • 1The Dartmouth Institute, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
JAMA Intern Med. 2015;175(5):809-811. doi:10.1001/jamainternmed.2015.0167

Everett Rogers’ classic monograph on the diffusion of innovations represents the process by which we adopt new ideas and practices as a smooth S-shaped curve. In this curve, the percentage of adoption increases incrementally over time, then shoots up exponentially and begins to level off as it approaches 90%.1 The path of diffusion in Rogers’ model progresses in the following order: innovators, early adopters, an early majority, a late majority, and laggards. More recent work has deepened the general understanding of the inherently complex psychological and social processes by which innovations are adopted and ultimately incorporated into routines by persons2 and service organizations.3

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1 Comment for this article
Uniffusion- or disinvestment?
Joanna Sutherland | Conjoint Senior Lecturer, UNSW Rural Clinical School, Coffs Harbour, Australia
Frank Davidoff has written a challenging article on the difficulties which face individual clinicians and specialist societies when contemplating the abandonment of established ineffective or superseded clinical practices. Davidoff suggests the term 'undiffusion' as the most appropriate descriptor of this behavior. Alternatively, the term 'disinvestment' has been used. Disinvestment may be a preferred descriptor in an environment where value for interventions and services is a priority. http://www.anzhealthpolicy.com/content/4/1/23