In 1984, the federal government began a phased implementation of a reimbursement method which pays hospitals a fixed fee based on diagnosis for care given to Medicare patients. The purpose of this study was to attempt to identify variables which facilitate head nurse's adoption of prospective reimbursement and develop a model to explain the adoption process.

Head nurses at a university teaching hospital were surveyed four times between October 1984 and March 1987. Change in score on the Stage of Concern about Innovation (SOCI) tool was the dependent variable. Eight hypotheses related to head nurse's sociodemographics and characteristics of work unit's task environment were developed to evaluate the dependent variable. One hypothesis predicting that head nurses with Master's degrees would be more likely to adopt innovation was supported by the data at the.05 level of significance. Factor and regression analyses were utilized to develop models which could predict innovation adoption. Models were developed which explained 18% to 35% of the variance in SOCI score.

Study limitations include use of only one institution and reorganizations which occurred during the study. The longitudinal design and detailed description of organizational changes are study strengths.