Slides from the first North East Hampshire and Farnham evaluation symposium on prevention, which took place on the 10 January 2017.

1. EVALUATING TEAMS WORKING
IN NEW MODELS OF CARE [NCMs]
Author and co-presenter:
Dr Catherine B Matheson-Monnet
c.b.matheson@soton.ac.uk
Co-presenter: Philippa Darnton
philippa.darnton@wessexahsn.net

2. Which of the following QI projects is most likely to fail?
A. No shared understanding
of purpose and outcomes
B. People not open to work
in new ways/not
legitimate part of work
C. Work not assigned to
those with required
skills/insufficient training
provided
D. People cannot modify
how they work as a result
of feedback
E. Other
No
shared
understandingof...
People
notopen
to
w
ork
in...
W
ork
notassigned
to
those
...
People
cannotm
odify
how
...
Other
0% 0% 0%0%0%

3. The least important factor for a successful QI project?
A. How it differs from usual
ways of working
B. Key people drive it
forward and get others
involved
C. Can easily be integrated
into existing work
D. People agree that it is
worthwhile
E. Other
How
itdiffersfrom
usualw
a..
Keypeople
drive
itforw
ard
...
Can
easily
be
integrated
into...
People
agree
thatitisw
ort...
Other
0% 0% 0%0%0%

4. The most important factor for a successful QI project?
A. How it is conceptualised
and understood
B. How team members
decide to engage and
actually engage
C. How the work is organised
and activities structured
and constrained
D. How it is appraised and
the effects of appraisal
E. Other
How
itisconceptualised
and...
How
team
m
em
bersdecide
..
How
the
w
orkisorganised
a..
How
itisappraised
and
the
e...
Other
0% 0% 0%0%0%

5. LEARNING OUTCOMES
1. To explain what NPT is and how it can
be used in evaluating New Care Models
2. To describe how NPT was used in
Farnham Integrated Care Team and the
Enhanced Recovery at Home Team

6. Which of the following statements
applies best to you?
A. No idea what NPT is
about
B. Have heard of NPT,
but not sure what it
is
C. Know what NPT is,
but I have not used it
D. Know about NPT and
have used it
No
ideaw
hatNPT
isabout
Have
heard
ofNPT,butnot...
Know
w
hatNPT
is,butIhav...
Know
aboutNPT
and
have
us..
0% 0%0%0%

7. 1
To explain what NPT is and how it can be
used in evaluating New Care Models and
new teams

8. NPT – NORMALISATION PROCESS THEORY
(May and Finch 2009; May et al, 2007, 2009, 2010; Finch et al 2013, 2015)
A validated sociological instrument widely used to
evaluate the implementation of QI interventions in
Healthcare
Evaluates the contribution of individuals and teams
focussing on factors that promote and inhibit
implementation
Explains how QI interventions become embedded in
routine every day practice
Within certain limits NPT has predictive potential and
this diagnostic dimension can help address early
problems and remedy them

9. NPT PRINCIPLES AND ASSUMPTIONS
(May and Finch, 2009)
Either QI interventions become routinely embedded in
every day work or not
Implement, embed and sustain is operationalised
through 4 domains: 1) coherence; 2)cognitive
participation; 3) collective action; 4) reflexive monitoring
Activities in all 4 domains may occur concurrently
Sustainability requires continuous and on-going
investment through collective action

10. 1/COHERENCE Differentiation
Mobilisation
How it is conceptualised and
held together in action
2/COGNITIVE
PARTICIPATION
Initiation
Participation
How team members decide
to engage and actually
engage
3/COLLECTIVE
ACTION
Interactional
workability
Enacting
How work is organised and
activities structured and
constrained
4/REFLEXIVE
MONITORING
Systematisation
Appraisal
How it is appraised and
effects of appraisal i.e. how
it is ‘understood’
NPT 4 DOMAINS

11. What is the most important factor
for a successful QI project?
1. How it is conceptualised and understood:
 coherence
2. How team members decide to engage and actually
engage:
 cognitive participation
3. How the work is organised and activities structured and
constrained:
 collective action
4. How it is appraised and the effects of appraisal:
 reflexive monitoring

12. NPT CAN BE USED BEFORE, DURING AND
AFTER QI INTERVENTIONS
BEFORE
• views of the team about how they think the NCM will impact on
their work
• expectations of the team about whether the NCM could become
a routine part of their work
• suggestions of the team for routine embedding of the NCM
DURING (at various time points)
• to ascertain the extent to which perceptions have changed
• identify areas (within the 4 key domains) that might require
additional work to enable embedding
AFTER
• to assess the extent to which routine embedding has achieved
sustainability

13. NPT CAN BE USED WITH ANY STUDY DESIGN
NPT is compatible with quantitative and qualitative
data collection and all research designs
Constructs and components can be translated into
simple statements for managers, clinicians,
researchers to help them think through and work
through implementation problems.
NPT 16 questions [4 for each of the 4 domains]
(May and Finch, 2009)
NPT derived NoMAD instrument [20 questions
between 4 and 7 for each of the 4 domains (Finch
et al, 2013, 2015) SEE NEXT SLIDE

14. COHERENCE 1. How NCM differs from usual ways of working
2. Shared understanding of purpose of the NCM
3. How NCM affects nature of work
4. Construct potential value for NCM re work
COGNITIVE
PARTICIPATION
5. Key people drive NCM forward
6. Participating in NCM is legitimate part of role
7. Open to working in new ways
8. Continued support for NCM
COLLECTIVE
ACTION
9. NCM can easily be integrated into existing work
10. NCM does not disrupt working relationships
11. Confidence in others’ skills and expertise
12. Work is assigned to those with appropriate skills
13. Sufficient training provided
14. Sufficient resources available to support NCM
15. Management adequately support the NCM
REFLEXIVE
MONITORING
16. Awareness of information about effects of NCM
17. NCM worthwhile
18. Value effects that NCM has on own work
19. Feedback about NCM can be used to improve it

15. 2
To describe how NPT was
used for ICT and ER@H

16. Integrating primary care (GP and HCPs) and
community/social care to provide a holistic service to those
at risk
 Service in place for 18 months + weekly MDT meetings to
discuss new and follow-up patients
Planning increased GP input to core team and closer
working with ambulance service and FPH A&E team.
 Data gathering re tracking service impact on
unplanned care, analysis of health care utilisation
before and after the intervention, patient
experience and PROMS, interviews with
patients/carers
FARNHAM INTEGRATED CARE TEAM

17. ICT:
Summative evaluation of early implementation
using structured focus groups with survey during
one day development meeting [n=9]
Evaluate the impact in respect of the experience
of staff involved in the delivery
Identify areas for further development

18. Merging secondary care provision [FPH FORT] with community-
based provision [SHFT RR] to provide an integrated holistic
service to those that may benefit
Interim service with 6/18 staff in post. Collaboration, joint
training and joint patients visits already in place. Significant
period of change for all staff involved.
Preparatory work over approx 9 months to develop a vision for
the ER@H service, explore shared values and processes and to
foster a common vision in preparation for the launch
 Data gathering re tracking service impact on unplanned
care and patient experience. Staff experience away
surveyed through R-Outcomes at away day in September
FARNHAM ENHANCED RECOVERY AT HOME

19. ER@H:
Formative evaluation of developmental phase
using non-participant observation during staff
away day [n=40]
Capture any significant learning from the
developmental phase
Identify potential challenges in implementing the
intervention before it is properly launched

20. LEARNING OUTCOMES
1. We explained what NPT was and how
it can be used in evaluating New Care
Models
2. We described how NPT was used for
understanding the impact of New Care
Models on two teams: ICT and ER@H

21. Are you likely to use NPT in future?
A. Yes
B. No
C. Not sure
Yes
No
Notsure
0% 0%0%

22. REFERENCES
Finch TL, Rapley T, Girling M, Mair FS, Murray E, Treweek S, McColl E, Steen I and May CR (2013) Improving
the normalization of complex interventions: measure development based on normalization process theory
[NoMAD]: study protocol, Implementation Science, 8, 1, 43. DOI:10.1186/1748-5908-8-43
Finch TL, Girling M, May CR, Mair FS, Murray E, Treweek S, Steen IN, McColl EM, Dickinson C, Rapley T (2015)
NOMAD: Implementation measure based on the Normalisation Process Theory [Measurement Instrument].
Available at http:www.normalisation process.org [Accessed 7 July 2016]
May CR, and Finch TL (2009) Implementation, embedding and integration: an outline of Normalization
Process Theory, Sociology, 43, 3: 535-554. DOI:10.1177/0038038509103208
May CR, Murray E, Finch TL, Mair F, Treweek S, Ballini L, Macfarlane A and Rapley T (2010) Normalization
Process Theory On-line Users’ Manual and Toolkit. Available from http://www.normalizationprocess.org
http://www.normalizationprocess.org/npt-toolkit/how-to-use-the-npt-toolkit.aspx [Accessed on 25th Sept
2015]
May C, Finch TL, Mair FS, Ballini L, Dowrick C, Eccles M, Gask L, MacFarlane A, Murray E, Rapley T, Rogers A,
Treweek S and Wallace P (2007) Understanding the Implementation of Complex Interventions in Health Care:
The Normalization Process Model, BMC Health Services Research, 7, 148.
May, CR, Mair F, Finch TL, MacFarlane A, Dowrick C, Treweek S, ,Rapley T, Ballini L, Ong BN, Rogers A, Murray
E, Elwyn G, Legare F, Gunn J and Montori VM. (2009) An interdisciplinary theory of implementation,
embedding and integration: the development of normalization process theory, Implementation
Science, 4, 29, DOI:10.1186/1748-5908-4-29