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Implementation Toolkit: using Normalization Process Theory to implement and evaluate complex interventions and new technologies in healthcare
npt the npt toolkit for evaluating health technologies and complex interventions carl may, tracy finch, lucianna ballini, anne macfarlane, elizabeth murray, frances mair, shaun treweek, tim rapley www.normalizationprocess.org the authors 2010 contact firstname.lastname@example.org this presentation introduces basic concepts of normalization process theory (npt) and the not toolkit purpose of the not 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 quick introduction to npt 3/33 ''normalization process theory explains factors that promote and inhibit implementation , and explains how complex interventions in health care become embedded and integrated in practice'' ''theory lite? theories are abstract and need to be translated for everyday users. constructs and components of npt can be translated into simple statements for managers, clinicians, and researchers. simplified statements are heuristic devices to think through implementation problems, not to measure them'' ''what is a complex intervention? 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. deliberate initiation means that an intervention is: institutionally sanctioned; formally defined, consciously planned; and intended to lead to a changed outcome 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.'' ''complex interventions 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) 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) elements of complex interventions aimed at contexts often to seek to change the procedures enacted to achieve goals. (e.g. didgital delivery, or organisational stractures) most complex interventions engage with multiple actors, objects, and contexts simultaneously'' ''normalization process theory * explains how interventions become routinely embedded in their contexts * explains routine embedding by reference to four mechanisms (coherence; cognitive participation; collective action; reflexive monitoring). explains how the work, (individually and collective), of implementing interventions requires invesment in action.'' four constructs of npt coherence: defines and organizes the components of a practice collective action: defines and organizes the enacting of a practice cognitive participation: defines and organizes the people implicated in a complex intervention reflexive monitoring: defines and organizes assessment of the outcomes of a practice normalization process theory focuses on the work that people do processes of individual and communal coherence and sense making processes of cognitive participation processes of collective action processes of individual and communal reflexive monitoring full stop it's all about the work what is the work? who does the work? how does the work get get done? why did the work happen like that? quick introduction to the npt toolkit ''www.normalizationprocess.org is an on-line resource to help clinicians, managers, and researchers think through problems of implementation, embedding, and integration is not a validated survey instrument is a resource that can be used when planning or appraising the implementation and integration of a new technology or complex intervention'' www dot normalizationprocess dot org provides clinicians comma managers comma and researches with a toolkit to think through key issues around implementation comma embedding comma and integration components of coherence work differentiation defines an [intervention] and organises its relationships with other practices and contexts; communal specification or co-ordination forms and organises shared beliefs and knowledge about the purpose of the [intervention]; individual specification forms and organises personal beliefs and knowledge about the demands of the [intervention]; internalization defines the value of the [intervention] to its users. toolkit items assessing coherence work (participants) distinguish the (intervention) from current ways of working (participants) collectively agree the purpose of the (intervension) (participants) individually understand what the (intervention) requires of them? (participants) construct potential value of the (intervention) for their work toolkit users can use slide-bars to begin to work through their subjective assessment of coherence work component of participation work initiation brings an intervention into practice legitimation forms and organises shared beliefs about the legitimacy of participating in the intervention enrolment forms and organises the ways that participants join the intervention activation forms and organises the ways that paticipants continue to support the intervention toolkit items assessing participation work key [participants] drive forward the [intervention] [participants] agree that the [intervention] is a legitimate part of their work [participants] join in delivering the [intervention] [participants] continue to support the [intervention] tool-kit users can use slide-bars to begin to work through their subjective assessment of participation work toolkit items assessing enacting work [participants] perform the tasks required by the [intervention] [participants] maintain trust in each others' work and expertise through the [intervention] the work of the [intervention] is appropriately allocated to [participants] the [intervention] is adequately supported by its host organization components of appraisal work systematizing forms and organises knowledge about the effects of the [intervention] communal appraisalpeople work together to assess whether the effects of the [intervention] are worthwhile for others individual appraisal people assess whether the effects of an [intervention] are worthwhile forthemselves reconfiguration organizes changes in the ways that the [intervention] is enacted questions assessing appraisal work [participants] access information about the effects of the [intervention] [participants] collectively assess the [intervention] as worthwhile for others [participants] individually assess the [intervention] as worthwhile for themselves [participants] modify their work in response to their appraisal of the [intervention] toolkit users can use slide-bars to begin to work through their subjective assessment of monitoring work the results page provides a global picture of implementation work in relation to npt ''www.normalizationprocess.org npt focuses attention on factors already empirically demonstrated to be important in promoting or inhibiting implementation, embedding, and integration of complex interventions the toolkit provides a simmplified version of npt suitable for use as an aid to critical thinking'' ''key papers may c, finch t. implementation, embedding, and integration: an outline of normalization process theory sociology 2009, 43:535-54. available here may c, et al. development of a theory of implementation and integration: normalization process theory implementation science 2009; available here npt'' normalization process theory this work was supported by the uk economic and social research council (grant 189250003) esrc economic & social research council npt