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Normalization Process Theory:
Understanding the dynamics of complex healthcare interventions
 Everyone is interested in innovation in healthcare. Innovation promises better ways of organizing and delivering treatment, improvements in the clinical and cost-effectiveness of services, and reductions in the burdens of illness - especially chronic illness. Most research on healthcare innovation focuses on the outcomes of innovations - measuring their impact and exploring their effects - but this doesn't always tell us the things that we need to know. Researchers try to help healthcare providers by quantifying outcomes and comparing the effects of these innovations. But it is also understood that outcomes evaluations are not enough, and that we need to perform process evaluations that help us to understand how these effects come about.
Identifying and adopting an innovative health technology, or a new way of organizing professional work, is the beginning of the story, not the end. Down the line, policy-makers, managers, professionals, and patients all face two important problems as they try to get innovations into practice.
- Process problems: about the implemention of new ways of thinking, acting and organizing in health care
- Structural problems: about the integration of new systems of practice into existing organizational and professional settings.
These are important problems for researchers and evaluators too. To understand implementation and integration, they need focus on the dynamic processes that lead to innovations become embedded in everyday work. Normalization Process Theory is an explanatory model that helps managers, clinicians, and researchers understand the dynamic processes that occur when people put new technologies and complex interventions into practice.
Normalization Process Theory focuses on the work that people do when they seek to implement and integrate an innovation. It starts with the question:
- What factors promote or inhibit the routine embedding of healthcare technologies and complex interventions, and, how can these be understood and explained?
There's nothing so practical as a good theory, and this website will guide you through the uses of NPT, and some of the theory's basic concepts. It will also help you to work through some of NPT's applications. Of course, no web page can be a substitute for the scientific journal articles in which Normalization Process Theory has been developed and elaborated. Links to open access papers are provided in the bibliography.
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| Key references: May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology 2009, 43(3):535-554. May C, Mair FS, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A et al: Development of a theory of implementation and integration: Normalization Process Theory. Implementation Science 2009, 4(29).
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