Table 3 Adaptation of definitions from the diffusion of innovation theory to the study context

Perceived attributes of innovation

Relative advantage

Degree to which adoption of mandatory safety and quality standards is perceived as better than retaining status quo. It is a ratio of the expected benefits (e.g. better professional reputation, better management, improved patient satisfaction, economic profitability) and the costs of adoption (e.g. disadvantages to the provider).

Observability

Degree to which the results of adoption of mandatory safety and quality standards are visible to others (e.g. patients, peers, inspection, health insurance fund, line ministry)

Communication channels

Mass media channels

All the means of transmitting messages, involving a mass medium (television, radio, Internet or press), through which audience of many PHPs and public got information on certification process.

Interpersonal channels

Face-to face exchange of information on mandatory safety and quality standards between owners of PHPs and other individuals (e.g. peers, both adopters and non-adopters of the standards; representatives of other organizations).

Innovation decision process

Knowledge

Exposure of PHP’s owner to information on safety and quality standards and gaining of understanding on how the certification process functions.

Persuasion

Forming of PHP’s owner favorable, neutral or unfavorable attitude towards the certification standards and process.

Decision

Engaging of PHP’s owner in activities leading to a choice to adopt or reject the certification standards and process.

Social system

Collective innovation-decision

Choice to adopt or reject certification process that is made by consensus among the members of a health chamber or members of a professional association of private health care providers.