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The process by which administrators, physicians, and other health professionals develop decisions on the adoption of innovations was examined through a study of the decision process relating to the institutional use of a vaccine to prevent hepatitis B. Mail questionnaires and telephone follow-up interviews were used to collect data on the decision process in 56 Arizona hospitals in 1983 and 1984. A five-stage decision process was employed by the institutions. Critical stages in the process involved defining who would make the adoption decision and the collection of information related to the innovation. The institutional plans for vaccine distribution did not exhibit a clear consensus regarding the identification of high-risk employee groups. Employee acceptance of the vaccine, even with the cost paid by the hospital, was limited.