How early implementations influence later adoptions of innovation: social positioning and skill reproduction in the diffusion of robotic surgery

We report from a multi-level study investigating the diffusion of robotic surgery in the Italian health care system between 1999 and 2010. A combination of qualitative and quantitative methods allowed us to link organization-level processes associated to the adoption and implementation of the innovation with its diffusion at population level. Our findings advance our understanding of how early implementations influence later adoptions, by drawing attention to how search for social gains pushes some peripheral actors to pioneer a new technology or work practice, and to engage in practices of discursive persuasion and skill reproduction that constitute them as ‘exemplary users’ and that may eventually trigger and support isomorphic diffusion even in the presence of persisting uncertainty about the technical and/or economic benefits of the innovation.