A rational model for assessing and evaluating complex interventions in health care

Abstract

BackgroundUnderstanding how new clinical techniques, technologies and other complex interventions become normalized in practice is important to researchers, clinicians, health service managers and policy-makers. This paper presents a model of the normalization of complex interventions.MethodsBetween 1995 and 2005 multiple qualitative studies were undertaken. These examined: professional-patient relationships; changing patterns of care; the development, evaluation and implementation of telemedicine and related informatics systems; and the production and utilization of evidence for practice. Data from these studies were subjected to (i) formative re-analysis, leading to sets of analytic propositions; and to (ii) a summative analysis that aimed to build a robust conceptual model of the normalization of complex interventions in health care.ResultsA normalization process model that enables analysis of the conditions necessary to support the introduction of complex interventions is presented. The model is defined by four constructs: interactional workability; relational integration; skill set workability and contextual integration. This model can be used to understand the normalization potential of new techniques and technologies in healthcare settingsConclusionThe normalization process model has face validity in (i) assessing the potential for complex interventions to become routinely embedded in everyday clinical work, and (ii) evaluating the factors that promote or inhibit their success and failure in practice.

Organisational influences on nurses’ use of clinical decision support systems

“…Thus, barriers to such adaptation become barriers to the successful implementation of technology. May [16] highlights the importance of an organisation's intention and capacity to effectively integrate the technology into the organisation, suggesting a lack of such will and ability results in reduced likelihood of success. However, trying to change processes through the introduction of technology is seen as a dangerous approach.…”

“…Although nurses were observed (and reported) using the CDSS in ways probably not envisaged by the original designers of the system [26], all of the nurses who participated in this study considered the technology they used to be useful. Nurses had 'normalized' the CDSS into their working practices [16], developing strategies to deal with perceived inflexibility in the systems they used. In this way, the CDSS examined in this study can be considered as successful implementations.…”

The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic

“…Drake et al define evidence-based practices in mental health service settings as "interventions for which there is consistent scientific evidence showing that they improve client outcomes" [21] . Torrey et al mean that implementing evidence-based practices in mental health practice is difficult and complex [22][23][24][25] . Several psychiatric nursing care models have been implemented in healthcare, some more successfully than others [26][27][28] .…”

“…The chosen theory for the present study was Normalization Process Theory, Normalization Process Theory (NPT) [23][24][25] . This choice is based on the assumption that NPT is a theory of action aimed at discovering how people work and what they actually do when something new is to be implemented.…”

Process evaluation of infertility management in primary care: has open access HSG been normalized?

“…The outcome will be one of three scenarios: the intervention is unlikely to be cost-effective or work; the intervention is obviously beneficial and should be implemented immediately; or there is a state of equipoise and the intervention requires evaluation in a definitive trial. The Normalization Process Model (NPM) is an applied theoretical model that uses four constructs to predict or evaluate the uptake of a complex intervention such that it becomes routinely embedded (normalized) in everyday practice (May, 2006;May et al, 2007a). The NPM can be used to explain why open access HSG is used in one practice but not another.…”