MGMT 8805M Week 8 Adoption Analysis Example

Who Slowed the Handheld: An Adoption Analysis Charting Handheld Ultrasound's Spread Through One State's Emergency Departments, Testing the Innovation's Own Attributes Against the Interests of the People Whose Competence It Threatened, and Finding a Dated Delay

Student Name

Walden University

MGMT 8805M: Agile and Disruptive Innovation Management

Instructor Name

Month Day, Year

Who Slowed the Handheld: An Adoption Analysis Charting Handheld Ultrasound's Spread Through One State's Emergency Departments, Testing the Innovation's Own Attributes Against the Interests of the People Whose Competence It Threatened, and Finding a Dated Delay

Innovation, Market and Period

This analysis follows the adoption of handheld ultrasound, led by Pocketsound's probe, in the 64 hospital emergency departments of one composite Midwestern state between 2019 and 2025. Its claim is that the innovation's attributes favored rapid adoption, but radiology departments, whose competence the handheld threatened, delayed it by about eighteen months in hospitals where they controlled ultrasound credentialing.

The Adoption Record

[after]

Routine use means that handhelds were available on every shift and used in at least weekly documented scans, from a state emergency physicians' association survey. Credentialing control comes from hospital medical staff bylaws.

Table 1

Emergency Departments Using Handheld Ultrasound Routinely, by Year and Credentialing Control

The Attributes as Rival Explanation

Rogers (2003) identified five attributes that shape how fast an innovation spreads: relative advantage, compatibility with existing values and practice, complexity, trialability and observability. The handheld scores well on each. It is far cheaper than a cart, fits the bedside checks emergency physicians already perform, is simple to use with guidance software, can be trialed for a few thousand dollars and produces results colleagues can see. If attributes explained adoption, the two columns of the table would rise at similar rates, since both groups faced the same product. They did not.

Competence Destroyed, Inside the Market

Tushman and Anderson (1986) distinguished technological changes that enhance the competence of existing firms from those that destroy it, and found that competence-destroying changes were usually introduced by new entrants. This analysis extends their distinction from firms to groups of people within a market. For emergency physicians, the handheld enhanced competence: it extended skills they already used. For radiologists and sonographers, it destroyed part of theirs, since a bedside scan by an emergency physician replaced a study they would otherwise have performed and read.

The Stakeholder Map

Emergency physicians gained speed and independence and controlled purchasing within their departments' budgets. Radiology departments lost study volume and, where they controlled credentialing, could require emergency physicians to complete training and supervised scans before using handhelds. Hospital administrators gained lower costs but deferred to medical staff on credentialing. Payers were neutral until 2022, when a composite state payer began reimbursing bedside scans by credentialed physicians.

The Dated Delay

In the 26 hospitals where radiology controlled credentialing, departments adopted the handheld about eighteen months later than in hospitals where emergency medicine credentialed itself. The table shows that half of the first group had adopted by 2022, while half of the second group adopted only in 2024. Minutes from three radiology-controlled hospitals show the credentialing requirement, 150 supervised scans reviewed by a radiologist, adopted in 2021, the year handheld use began to grow. Greenhalgh et al. (2004), reviewing diffusion in health service organizations, found that innovations threatening professional boundaries often met resistance from the professions affected, which is consistent with this pattern.

The Payer Change as a Second Rival

A second rival explanation is the 2022 reimbursement change, which paid only for scans by credentialed physicians. If payment drove adoption, both groups should have accelerated after 2022, and they did: the radiology-controlled group went from 3 departments to 9 in a year. But the timing of the gap does not fit a payer explanation alone. The self-credentialing group had already reached 24 departments before payment began, and the radiology-controlled group's acceleration came only after its hospitals' credentialing programs graduated their first physicians in 2023. Payment made credentialing worth completing; it did not remove the delay that credentialing created.

What the Delay Cost

For Pocketsound, the delay meant that a third of the state's emergency departments stayed out of reach for about eighteen months. For patients in those hospitals, it meant fewer bedside scans during that period, though the analysis cannot say whether outcomes differed. For Brightwater, the delay was a reprieve it did not create and could not extend.

Limits of the Analysis

It cannot rule out that radiology-controlled hospitals differ in other ways, such as size or teaching status, that slowed adoption. Comparing hospitals of similar size would test that, as would checking whether the radiology-controlled hospitals were also slower to adopt other bedside technologies in the same years.

References

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.

Tushman, M. L., & Anderson, P. (1986). Technological discontinuities and organizational environments. Administrative Science Quarterly, 31(3), 439-465. https://doi.org/10.2307/2392832