Although they have not embedded themselves into marketing thinking as deeply as has Rogers, the work of Lave and Wenger lies beneath concepts such as ‘gatekeepers’, ‘champions’ and ‘influencers’. Their influence is therefore especially strong in models of adoption of complex, high-involvement products that require significant changes in practice or in the organisation. CoP theory has the obvious strength that it addresses group decision-making much better than DoI theory. However, although it has been used to explain the adoption of new clinical procedures, like its older predecessor theory, there has been little empirical application to the question of new product uptake in pharmaceuticals or medical technology.

Our painstaking review of the literature on new product uptake, especially in the life sciences, was the necessary foundation to our research. It told us that, although there are two well-established schools of academic thinking and that DoI in particular is often applied in practice, we have relatively little scientific evidence to support either of these ideas in the particular context of pharmaceuticals, medical technology and related markets. We simply don’t know which, if either, of these theories, is correct. It was this gap in our knowledge, important to both the industry and to society in general, that our research set out to fill.

To explore this gap, we decided to study the uptake of five different innovative medical technologies across multiple secondary care centres. Our research was both quantitative and qualitative. Our aim was not simply to look for correlations between factors but to get deep into the causative explanations for why new product adoption varied between products and between customers. As we examined both kinds of data, the question at the back of our minds was: ‘Does DoI or CoP best explain what we see in the real world or is it something else entirely?’ The research was detailed, laborious, has taken four years so far and it is not yet complete. Our findings, although preliminary and not yet published in the management literature, can be summarised in three important discoveries.

Firstly, both Rogers and Lave and Wenger were on to something. Unsurprisingly for such great minds, both schools of thought captured much of the complexity of the new product uptake phenomenon. All of the ideas summarised in boxes 1 and 2 were, to some extent, correct. But both theories were also inadequate. DoI highlights important factors such as ease of trial and product complexity but tends to place too much emphasis on the role of the individual. CoP balances this with a good understanding of group dynamics in decision-making but perhaps understates the changing level of the decision over time. It also completely ignores the product’s characteristics. The reality is that both sets of scholars are looking at the same problem but from different perspectives. They are seeing different sides of the same coin. In practice, this means that if you are an adherent of either theory (and most marketers are implicit disciples of Rogers), then you understand only half the story of new product adoption.

Second, both CoP and DoI describe important and specific factors that influence new product uptake but in both cases, if they are to be of any practical use, these factors need to be tailored to the specific case of medical markets. For example, DoI sees adoption as being modified by the appetite of adopters for innovation, that distinguishes ‘early adopters’ from ‘laggards’. This is true, but in medical markets, where patient well-being is the goal, this individual trait is tempered by risk aversion. Equally, CoP sees adoption as being a function of the intensity of interaction between the members. This is certainly true but in life sciences this factor is strongly moderated by the complex interplay of the various professions working together in healthcare institutions. In other words, we found that both CoP and DoI provided good tools for understanding and manipulating the adoption of innovative new products but those tools are like adjustable spanners: they work best only when fitted to the details of the situation and don’t work when used without adjustment. In practice, if you throw around the ideas of either DoI or CoP as bits of jargon, without really understanding them, you will not be able to manage or improve the adoption of your new product.

Our third and, we think, most significant finding was also connected to how the two theories of new product adoption apply to the practice of product launch and life cycle management in pharmaceuticals and medical technology.

Both theories consider new product adoption as happening at one level. In a medical context, for example, they see adoption as occurring in the clinical unit, such as an operating department or a cardiology lab. This is the truth, of course, but not the whole truth because, in practice, there are two other, simultaneous and interacting levels of adoption. Firstly, the adoption of the idea to fund for the new product or technology. This takes place in a separate decision stream, such as national heath technology assessment bodies and local formularies. Secondly, the adoption of the idea to refer the patient for treatment in this innovative way. This adoption process often takes place in a separate clinical sphere, such as when one healthcare professional, for example in primary care, must choose to refer to another, for example in secondary care. This means that, in many cases, managing and manipulating new product adoption involves thinking about how DoI and CoP factors play out at three parallel but connected levels at once. If your product launch or marketing strategy considers only one, you are unlikely to succeed.

Our research is the first of its kind to explore new product adoption in the life sciences in this rigorous, theory-based but practice-oriented way.

As academic researchers, we will be judged on how our findings contribute to the next generation of textbooks. But perhaps more important, and certainly more immediate, is the contribution we think this work makes to the everyday practice of pharmaceutical and medical technology marketers trying to accelerate their adoption of life-saving and enhancing products. We think there are three key lessons for marketers to learn from our research.

Firstly, stop thinking simplistically in terms of DoI. The concepts of innovators, early adopters, etc are useful but they are crude approximations to reality. Augment and improve your thinking by incorporating the ideas of Lave and Wenger, whose work is very relevant to the complex, cross-functional working of today’s health systems.

Secondly, don’t use the ideas of CoP or DoI without translating them into the specific context of medical markets. Both schools of thought developed their ideas in non-medical markets. This means that they have to be translated to allow, for example, for risk aversion and the complex interplay within multidisciplinary clinical teams.

Finally, broaden your thinking about how the adoption of new products works in pharmaceutical and medical technology markets. To address unmet patient needs means to simultaneously manage the three dimensions of professionals, payers and patient referral. Focusing on only one is a mistake.

As well as being academics, both of the authors of this article work as practitioners in pharmaceuticals and medical technology. We hope and believe that our findings are valuable to our fellow marketing practitioners. But we also think that our peers would do well to remember the words of the great thinker Kurt Lewin: there is nothing so practical as a good theory.

Matthieu LeClerc-Chalvet is CEO of Therapixel and a PhD candidate at the University of Hertfordshire. Professor Brian D Smith works at SDA Bocconi and the University of Hertfordshire. He is a world-recognised authority on the evolution of the life sciences industry and welcomes questions at brian.smith@pragmedic.com