Disseminating educational innovations in health care practice: Training versus social networks Erik Jippes a, * , Marjolein C. Achterkamp b , Paul L.P. Brand a, c , Derk Jan Kiewiet d , Jan Pols e , Jo M.L. van Engelen f a Postgraduate School of Medicine, Wenckebach Institute, University Medical Centre Groningen, University of Groningen, the Netherlands b Marketing, Faculty of Economics and Business, University of Groningen, the Netherlands c Princess Amalia Children’s Clinic, Isala Klinieken Zwolle, the Netherlands d Loyalis Business Development, the Netherlands e Wenckebach Institute, University Medical Centre Groningen, University of Groningen, the Netherlands f Product Development and Strategy, Faculty of Economics and Business, University of Groningen, the Netherlands article info Article history: Available online 12 February 2010 Keywords: The Netherlands Medical education Social networks Strong ties Weak ties Diffusion Dissemination Innovation Training Physicians Communication abstract Improvements and innovation in health service organization and delivery have become more and more important due to the gap between knowledge and practice, rising costs, medical errors, and the orga- nization of health care systems. Since training and education is widely used to convey and distribute innovative initiatives, we examined the effect that following an intensive Teach-the-Teacher training had on the dissemination of a new structured competency-based feedback technique of assessing clinical competencies among medical specialists in the Netherlands. We compared this with the effect of the structure of the social network of medical specialists, specifically the network tie strength (strong ties versus weak ties). We measured dissemination of the feedback technique by using a questionnaire filled in by Obstetrics & Gynecology and Pediatrics residents (n ¼ 63). Data on network tie strength was gathered with a structured questionnaire given to medical specialists (n ¼ 81). Social network analysis was used to compose the required network coefficients. We found a strong effect for network tie strength and no effect for the Teach-the-Teacher training course on the dissemination of the new structured feedback technique. This paper shows the potential that social networks have for disseminating innovations in health service delivery and organization. Further research is needed into the role and structure of social networks on the diffusion of innovations between departments and the various types of innovations involved. Ó 2010 Elsevier Ltd. All rights reserved. Introduction Innovation in health service delivery and organization has become a central issue. The reasons for it becoming so range from failure to use the available scientific knowledge (Richardson, 2001), to rapidly rising costs due to changing demographics and medical technology (Hartman, Martin, McDonnell, & Catlin, 2009), medical errors (Berwick, 2003), and the very organization of the health care systems themselves (Kuttner, 2008). Many innovation projects often fail to meet expectations. There are six forces which seem to drive or kill innovations: players (friends and foes), funding, policy, technology, customers, and accountability (Herzlinger, 2006). Many of the innovations in health care organizations are implemented by following a training course or other kind of education. The expenditure incurred for training and education is considerable. In the USA an average health care organization’s (500–999 FTE) annual training expenditure exceeds $150,000 (Controller’s Report, 2006). The average annual direct training expenditure per FTE in health care in the USA is $862, which constitutes on average 12% of profit (Corporate Training & Development Advisor, 2008). As a result, the question then arises as to how effective training and education actually are in distributing and transferring novel ideas, new health concepts, and technologies. Are there more * Corresponding author. Tel.: þ31 503619702. E-mail address: e.jippes@wenckebach.umcg.nl (E. Jippes). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ – see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2009.12.035 Social Science & Medicine 70 (2010) 1509–1517