and James, 2006; Saldana et al., 2007; Shortell et al., 2000, 2001). These studies suggest that health care and human services organizations are governed more by institutional factors, such as compliance with professional norms and public regulation, than by market competition factors associated with the behavior of commercial firms (Glisson et al., 2008; Mendel et al., 2008; Scott, 2001; Selznick, 1957).

Practices and programs are unlikely to be adopted if people have no knowledge of them. For example, a lack of awareness has been one of the reasons that physicians opt to not follow recommended care guidelines (Cabana et al., 1999). Intentions are more likely to lead to behavior change if they are coupled with plans for how and when the change will be implemented (Webb and Sheeran, 2006). This finding suggests that dissemination activities that encourage and support potential adopters in thinking through how they would implement it in their context will make the adoption of a new program or practice more likely (Frambach et al., 1998; Glennan, 1998). For example, the Agricultural Cooperative Extension Agent is a model of an iterative, facilitated dissemination in the United States that reaches every county in the United States and has nearly 100 years of proven, rapid dissemination that transformed American farms. Developed by the Agricultural Extension Service, this model was developed to build bridges from land-grant universities doing agricultural science, to the university regional director, to the local field office, to the farmers in the field (Vastag, 2004). In 2009 the American Recovery and Reinvestment Act included a health information technology extension agent function that could be broadened as a method for clinical practice quality improvement and research dissemination (Rural Health Resource Center, 2009).

Diffusion of innovation theory has been a popular way to frame the adoption of innovations in health care and social services (Berwick, 2003; Rogers, 1995). The theory emphasizes five attributes that improve the chances of adoption of an innovation:

1. its relative advantage over existing practice and other, similar innovations;

2. its compatibility with what people already believe and value;

3. its complexity;

4. the extent to which it can be observed in operation; and