Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript

Normalization Process Theory

Normalization Process Theory can help us understand the dynamics of implementing, embedding, and integrating a new practice, technology or complex intervention

There are four core constructs, each with four components

What is Normalization Process Theory?

Background

Background

NPT was initially developed following observed difficulty in implementing and integrating telemedicine systems, but has expanded to address any new treatment modality, care practice, technology, or way of organizing care in the health service setting.

The principle theorist is Dr. Carl May, a medical sociologist focusing on implementation science and health service research, although he credits over 70 colleagues for assisting in the creation of the NPT toolkit and resources.

Core Propositions

Core Propositions of NPT

(a) "Complex interventions become routinely embedded in their organizational and professional contexts as the result of people working, individually and collectively, to implement them."

(b) "The work of implementation is operationalized through four generative mechanisms [or constructs] (coherence; cognitive participation; collective action;reflexive monitoring)."

(c) "The work of integration of a complex intervention requires continuous investment by people in ensembles of action that carry forward in time and space".

(NPT, 2019. http://www.normalizationprocess.org/theory-behind-npt/core-propositions-of-npt/)

Core Constructs

Core Constructs

The core constructs represent the kinds of work that people do when implementing new practices, interventions or technologies.

1. Coherence

2. Cognitive Participation

3. Collective Action

4. Reflexive monitoring

References

References

May, C., Rapley, T., Mair, F.S., Treweek, S., Murray, E., Ballini, L., Macfarlane, A. Girling, M. and Finch, T.L. (2015) Normalization Process Theory On-line Users’ Manual, Toolkit and NoMAD instrument. Retrieved March 1, 2019 from http://www.normalizationprocess.org

May, C. R., Mair, F., Finch, T., Macfarlane, A., Dowrick, C., Treweek, S., . . . Montori, V. M. (2009). Development of a theory of implementation and integration: Normalization Process Theory. Implementation Science, 4(1). Retrieved March 2, 2019 from https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-29

Professor Carl May. (2019) Retrieved March 2, 2019 from https://www.southampton.ac.uk/healthsciences/research/staff/Carl_May.page

Coherence

Coherence refers to the work that people do individually and collectively to make sense of problem or to operationalize a practice

It has four components

Differentiation

Differentiation

Differentiation is the work done to understand how a set of practices and their objects are different from each other.

Communal Specification

Communal Specification

Communal specification is people working together to build an understanding of the aims, objectives, and expected benefits of a new practice, intervention or technology.

Individual Specification

Individual Specification

This is the individual work one has to do to understand their tasks and responsibilities around a new practice, intervention or technology.

Internalization

Internalization

This is work to understand the value, benefits and importance of a set of a new practice, intervention or technology.

Cognitive Participation

Cognitive Participation refers to the relational work that people do to build and sustain a community of practice related to a new technology or intervention

It has four components

Initiation

Initiation

With implementation of new practices, interventions or technologies, a core problem is whether participants are working to drive them forward.

Enrollment

Enrollment

Enrollment refers to the complex work of collaboration and the reorganization of relationships between individuals, groups, and things that may need to take place to facilitate the implementation of new practices, interventions or technologies.

Legitimation

Legitimation

This is the work to ensure that all participants believe in their involvement in a practice change and their confidence that they will make a meaningful contribution to it.

Activation

Activation

When a new practice, intervention or technology is undertaken, the actions and procedures required to sustain the practice need to be defined.

Collective Action

Collective Action is the operational work that people do to enact a set of practices. This may represent a new technology, complex healthcare intervention or practice.

It has four components

Collective Action

Interactional Workability

Interactional Workability

This refers to the interactional work that people do; which may include work with each other, with artefacts, or with certain elements of practices.

Relational Integration

Relational Integration

This refers to the work that people do towards accountability and to maintain confidence in practice, and in each other as they engage in practice.

Skill Set Workability

Skill Set Workability

This refers to the allocation work and division of labour that is arranged as new practices, interventions and technologies are operationalized.

Contextual Integration

Contextual Integration

This refers to the "resource work" of managing practices through the allocation of resources and the execution of protocols, policies and procedures.

Reflexive Monitoring

Reflexive Monitoring is the appraisal work that people need to do to assess and understand the ways that a new practice, intervention or technology will affect them and those around them

It has four components

Systematization

Systematization

This involves participants gathering information to determine the usefulness and effectiveness of a practice, intervention or technology for them and others.

Communal Appraisal

Communal Appraisal

This involves participants working together to evaluate the worth of a practice, intervention or technology. This can be achieved using various means within formal or informal groups.

Individual Appraisal

Individual Appraisal

This involves the appraisal of a new practice, intervention or technology by individuals; including their relationship to the new practice and its effects on them.

Reconfiguration

Reconfiguration

This is appraisal done by individuals or groups that may lead to attempts to redefine procedures, modify practices or make changes to a new practice, intervention or technology.

Critique

Critique

A weakness I perceive with NPT is a persistent theme in the terminology that I find nonspecific and misleading.

According to the website and literature, NPT's constructs represent the kinds of work that people do around implementing "a new practice." The website asserts that NPT can address any treatment modality, care practice, technology, or way of organizing care, but almost exclusively uses the term "sets of practices."

I have chosen not to use the terms "sets of practices" in my interpretation of the theory's constructs and components, because this terminology reduces my ability to apply the theory to my practice. Instead I have chosen to use "practices, interventions and technologies."

My primary work is the implementation of a clinical information system that will impact over a million people who access healthcare services in my region; with it comes significant change and a massive implementation effort. the scope of this work far exceeds a simple set of practices and considering NPT in this way limits my ability to envision its use in my work when, in reality, is is very applicable theory in principle.

I accept that this may be a due to a limitation in my comprehension of the terms, as I was surprised to read the NPT was created after the observation of difficulty implementing a telehealth intervention.

Learn more about creating dynamic, engaging presentations with Prezi