A toolkit for evaluating health technologies and complex interventions using Normalization Process Theory   Carl May, Trac...
this presentation <ul><li>introduces   basic concepts   of  Normalization Process Theory (NPT) and  the NPT Toolkit </li><...
quick introduction to NPT
normalization process theory <ul><li>explains factors that promote and inhibit  implementation , and explains how complex ...
theory lite? <ul><li>theories  are abstract and need to be translated for everyday users </li></ul><ul><li>constructs  and...
what is a complex intervention? <ul><li>a complex intervention is  any  deliberately initiated attempt to introduce new, o...
complex interventions <ul><li>elements of complex interventions directed at  actors  often seek to change  behaviour  and ...
normalization process theory <ul><li>explains how interventions become  routinely embedded  in their contexts </li></ul><u...
four constructs of NPT reflexive Monitoring :  defines and organizes assessment of the outcomes of  a practice cognitive P...
normalization process theory focuses on the  work  that people do <ul><li>processes of individual and communal  coherence ...
it’s all about the work <ul><li>what  is the work? </li></ul><ul><li>who  does the work? </li></ul><ul><li>how  does the w...
quick introduction to the NPT toolkit
www.normalizationprocess.org <ul><li>is  an on-line resource to help clinicians, managers, and researchers think through p...
www.normalizationprocess.org  provides clinicians, managers, and researchers with a toolkit to think through key issues ar...
components of coherence work <ul><ul><li>differentiation  defines an [intervention] and organises its relationships with o...
toolkit items assessing coherence work <ul><li>[participants]  distinguish  the [intervention] from current ways of workin...
toolkit users can use slide-bars to begin to work through their subjective assessment of coherence work
components of participation work <ul><li>initiation  brings an [intervention] into practice;  </li></ul><ul><li>legitimati...
toolkit items assessing participation work <ul><li>[participants]  work to   initiate  the [intervention] </li></ul><ul><l...
toolkit users can use slide-bars to begin to work through their subjective assessment of participation work
components of collective action <ul><li>skill-set work  of allocation and performance of the tasks related to an [interven...
toolkit items assessing enacting work <ul><li>[participants]  perform   the tasks  required by the [intervention] </li></u...
toolkit users can use slide-bars to begin to work through their subjective assessment of collective action
components of appraisal work <ul><li>systematizing  forms and organises knowledge about the effects of the [intervention] ...
questions assessing appraisal work <ul><li>[participants]  access   information  about the effects of the [intervention]  ...
toolkit users can use slide-bars to begin to work through their subjective assessment of monitoring work
interpreting results <ul><li>interpreting the report </li></ul><ul><ul><li>reports consist of a primary graph that represe...
the results page provides a global picture of implementation work in relation to NPT
the results page provides specific feedback on implementation and embedding – relating these to the four constructs of NPT
www.normalizationprocess.org <ul><li>NPT focuses attention on factors already empirically demonstrated to be important in ...
key papers <ul><li>May C, Finch T.  Implementation, embedding, and integration: an outline of Normalization Process Theory...
normalization process theory <ul><li>This work was supported by the UK Economic and Social Research Council (Grant  189250...
<ul><li>Carl May </li></ul><ul><li>Professor of Healthcare Innovation </li></ul><ul><li>Faculty of Health Sciences </li></...
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A toolkit for complex interventions and health technologies using normalization process theory

  1. 1. A toolkit for evaluating health technologies and complex interventions using Normalization Process Theory Carl May, Tracy Finch, Luciana Ballini, Anne MacFarlane, Elizabeth Murray, Frances Mair, Shaun Treweek, Tim Rapley www.normalizationprocess.org © The authors 2010/ contact berg206@gmail.com
  2. 2. this presentation <ul><li>introduces basic concepts of Normalization Process Theory (NPT) and the NPT Toolkit </li></ul><ul><li>purpose of the NPT toolkit is to provide managers, clinicians and researchers with a robust conceptual model of implementation and integration processes around new health technologies and complex interventions </li></ul>
  3. 3. quick introduction to NPT
  4. 4. normalization process theory <ul><li>explains factors that promote and inhibit implementation , and explains how complex interventions in health care become embedded and integrated in practice </li></ul>
  5. 5. theory lite? <ul><li>theories are abstract and need to be translated for everyday users </li></ul><ul><li>constructs and components of NPT can be translated into simple statements for managers, clinicians, and researchers </li></ul><ul><li>simplified statements are heuristic devices to think through implementation problems, not to measure them </li></ul>
  6. 6. what is a complex intervention? <ul><li>a complex intervention is any deliberately initiated attempt to introduce new, or modify existing, patterns of collective action in health care or some other formal organizational setting. </li></ul><ul><li>deliberate initiation means that an intervention is: institutionally sanctioned; formally defined; consciously planned; and intended to lead to a changed outcome . </li></ul><ul><li>initiators of a complex intervention may seek to modify the ways that people think, act and organize themselves in health care , or they may seek to initiate a process with the intention of creating a new outcome. </li></ul>
  7. 7. complex interventions <ul><li>elements of complex interventions directed at actors often seek to change behaviour and its intended outcomes (e.g. strategies for making ‘expert patients’; or new professional roles) </li></ul><ul><li>elements of complex interventions aimed at objects often seek to change expertise and actions ( e.g. novel therapeutic agents and medical devices; or decision-making tools and clinical guidelines) </li></ul><ul><li>elements of complex interventions aimed at contexts often to seek to change the procedures enacted to achieve goals. (e.g. digital delivery, or organisational structures) </li></ul><ul><li>most complex interventions engage with multiple actors, objects, and contexts simultaneously </li></ul>
  8. 8. normalization process theory <ul><li>explains how interventions become routinely embedded in their contexts </li></ul><ul><li>explains routine embedding by reference to four mechanisms (coherence; cognitive participation; collective action; reflexive monitoring). </li></ul><ul><li>explains how the work, (individually and collective), of implementing interventions requires investment in action. </li></ul>
  9. 9. four constructs of NPT reflexive Monitoring : defines and organizes assessment of the outcomes of a practice cognitive Participation : defines and organizes the people implicated in a complex intervention collective Action : defines and organizes the enacting of a practice coherence : defines and organizes the components of a practice
  10. 10. normalization process theory focuses on the work that people do <ul><li>processes of individual and communal coherence and sense making. </li></ul><ul><li>processes of cognitive participation . </li></ul><ul><li>processes of collective action . </li></ul><ul><li>processes of individual and communal reflexive monitoring . </li></ul>
  11. 11. it’s all about the work <ul><li>what is the work? </li></ul><ul><li>who does the work? </li></ul><ul><li>how does the work get get done? </li></ul><ul><li>why did the work happen like that? </li></ul>
  12. 12. quick introduction to the NPT toolkit
  13. 13. www.normalizationprocess.org <ul><li>is an on-line resource to help clinicians, managers, and researchers think through problems of implementation, embedding, and integration </li></ul><ul><li>is not a validated survey instrument </li></ul><ul><li>is a resource that can be used when planning or appraising the implementation and integration of a new technology or complex intervention </li></ul>
  14. 14. www.normalizationprocess.org provides clinicians, managers, and researchers with a toolkit to think through key issues around implementation, embedding, and integration
  15. 15. components of coherence work <ul><ul><li>differentiation defines an [intervention] and organises its relationships with other practices and contexts; </li></ul></ul><ul><ul><li>communal specification or co-ordination forms and organises shared beliefs and knowledge about the purpose of the [intervention]; </li></ul></ul><ul><ul><li>individual specification forms and organises personal beliefs and knowledge about the demands of the [intervention]; </li></ul></ul><ul><ul><li>internalization defines the value of the [intervention] to its users. </li></ul></ul>
  16. 16. toolkit items assessing coherence work <ul><li>[participants] distinguish the [intervention] from current ways of working </li></ul><ul><li>[participants] collectively agree the purpose of the [intervention] </li></ul><ul><li>[participants] individually understand what the [intervention] requires of them? </li></ul><ul><li>[participants] construct potential value of the [intervention] for their work </li></ul>
  17. 17. toolkit users can use slide-bars to begin to work through their subjective assessment of coherence work
  18. 18. components of participation work <ul><li>initiation brings an [intervention] into practice; </li></ul><ul><li>legitimation forms and organises shared beliefs about the legitimacy of participating in the [intervention]; </li></ul><ul><li>enrolment forms and organises the ways that participants join in the [intervention] </li></ul><ul><li>activation forms and organises the ways that participants continue to support the [intervention] </li></ul>
  19. 19. toolkit items assessing participation work <ul><li>[participants] work to initiate the [intervention] </li></ul><ul><li>[participants] agree that the [intervention] is a legitimate part of their work </li></ul><ul><li>[participants] join in delivering the [intervention] </li></ul><ul><li>[participants] continue supporting the [intervention] </li></ul>
  20. 20. toolkit users can use slide-bars to begin to work through their subjective assessment of participation work
  21. 21. components of collective action <ul><li>skill-set work of allocation and performance of the tasks related to an [intervention]; </li></ul><ul><li>relational integration in which confidence and accountability of an [intervention] are formed and organised; </li></ul><ul><li>interactional work in which the [intervention] is a vehicle for deciding and disposing of operational problems; </li></ul><ul><li>contextual integration in which material and interpersonal resources are realised and policies and procedures executed to support the [intervention]. </li></ul>
  22. 22. toolkit items assessing enacting work <ul><li>[participants] perform the tasks required by the [intervention] </li></ul><ul><li>[participants] maintain trust in each others’ work and expertise through the [intervention] </li></ul><ul><li>the work of the [intervention] is allocated appropriately to [participants] </li></ul><ul><li>the [intervention] is supported adequately by its host organization </li></ul>
  23. 23. toolkit users can use slide-bars to begin to work through their subjective assessment of collective action
  24. 24. components of appraisal work <ul><li>systematizing forms and organises knowledge about the effects of the [intervention] </li></ul><ul><li>communal appraisal people work together to assess whether the effects of the [intervention] are worthwhile for others </li></ul><ul><li>individual appraisal people assess whether the effects of an [intervention] are worthwhile for themselves </li></ul><ul><li>reconfiguration organizes changes in the ways that the [intervention] is enacted </li></ul>
  25. 25. questions assessing appraisal work <ul><li>[participants] access information about the effects of the [intervention] </li></ul><ul><li>[participants] collectively appraise the [intervention] as worthwhile for others </li></ul><ul><li>[participants] individually appraise the [intervention] as worthwhile for themselves </li></ul><ul><li>[participants] modify their work in response to their appraisal of the [intervention] </li></ul>
  26. 26. toolkit users can use slide-bars to begin to work through their subjective assessment of monitoring work
  27. 27. interpreting results <ul><li>interpreting the report </li></ul><ul><ul><li>reports consist of a primary graph that represents all 16 items, and four graphs that describe responses for each of the theory's four constructs.  </li></ul></ul><ul><ul><li>to properly interpret graphic results users need to familiarize themselves with the core constructs of NPT. </li></ul></ul><ul><li>health warning </li></ul><ul><ul><li>the toolkit is not a scientific instrument. The bars do not provide objective scores for variables. </li></ul></ul><ul><ul><li>they are heuristic tools to think through an implementation or integration process. </li></ul></ul><ul><ul><li>instruments to measure NPT constructs need to be constructed using a different set of techniques. </li></ul></ul>
  28. 28. the results page provides a global picture of implementation work in relation to NPT
  29. 29. the results page provides specific feedback on implementation and embedding – relating these to the four constructs of NPT
  30. 30. www.normalizationprocess.org <ul><li>NPT focuses attention on factors already empirically demonstrated to be important in promoting or inhibiting implementation, embedding, and integration of complex interventions </li></ul><ul><li>the toolkit provides a simplified version of NPT suitable for use as an aid to critical thinking </li></ul>
  31. 31. key papers <ul><li>May C, Finch T. Implementation, embedding, and integration: an outline of Normalization Process Theory . Sociology 2009; 43:535-54. Available here </li></ul><ul><li>May C, et al . Development of a theory of implementation and integration: Normalization Process Theory . Implementation Science 2009; art4. Available here . </li></ul>
  32. 32. normalization process theory <ul><li>This work was supported by the UK Economic and Social Research Council (Grant 189250003) </li></ul><ul><li>. </li></ul>
  33. 33. <ul><li>Carl May </li></ul><ul><li>Professor of Healthcare Innovation </li></ul><ul><li>Faculty of Health Sciences </li></ul><ul><li>University of Southampton </li></ul><ul><li>Southampton, UK </li></ul><ul><li>[email_address] </li></ul>

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