Normalization process model
Encyclopedia
The Normalization Process Model is a theory that explains how new technologies are embedded in health care work . The model was developed by Carl R May and co-workers , and is an empirically derived grounded theory
in medical sociology
and Science and Technology Studies
(STS
), based on qualitative methods. Carl May developed the model after he appeared as a witness at a British House of Commons
Health Committee Inquiry on New Medical Technologies in the NHS in 2005 . He asked how new technologies became routinely embedded, and taken-for-granted, in everyday work, in view of the increasing corporate organization
and regulation
of healthcare. The model explains embedding by looking at the work that people do to make it possible.
The model is a theory
in sociology that fits well with macro approaches to innovation
like the diffusion of innovations
theory developed by Everett Rogers
. Although the Normalization Process Model is limited in scope to healthcare settings recent work by May and colleagues has led to the development of Normalization Process Theory
, which presents a general sociological theory of implementation and integration of technological and organizational innovations. Normalization Process Theory
has now superseded the more limited Normalization Process Model.
The Normalization Process Model provides a framework for process evaluation and also for comparative studies of complex interventions, especially of randomized controlled trials. Clinical trials and other evaluations of healthcare interventions often focus on the complex relationships between actors, objects and contexts, making a simple explanatory model, that fits well with other frameworks a necessary tool for clinical and health service researchers. In the Normalization Process Model, A complex intervention is defined as a deliberately initiated attempt to introduce new, or modify existing, patterns of collective action in health care.
A complex intervention has three kinds of components :
1. Actors are the individuals and groups that encounter each other in health care settings. They can include physicians, other health professionals, managers, patients, and family members. The aims of interventions aimed at actors are often to change people’s behaviour and its intended outcomes.
2. Objects are the institutionally sanctioned means by which knowledge and practice are enacted. They can include procedures, protocols, hardware, and software The aims of interventions aimed at objects often include changing people’s expertise and actions.
3. Contexts are the physical, organisational, institutional, and legislative structures that enable and constrain, and resource and realize, people and procedures. The aims of interventions aimed at contexts are often to change the ways that people organize their work to achieve goals in health care (or other) services.
The normalization process model explains theembedding of complex interventions by reference to four constructs of collective action that are demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration)in a rigorous and sound theory .
1. Interactional workability: This describes how a complex intervention is operationalized by the people using it. A complex intervention will affect co-operative interactions over work (its congruence), and the normal pattern of outcomes of this work (its disposal). Therefore: a complex intervention is disposed to normalization if it confers an interactional advantage in flexibly accomplishing congruence and disposal of work.
2. Relational integration: This describes how knowledge and work is mediated and understood within the social networks of people around it. A complex intervention will affect not only the knowledge required by its users (its accountability), but also the ways that they understand the actions of people around them (its confidence). Therefore: a complex intervention is disposed to normalization if it equals or improves accountability and confidence within networks.
3. Skill-set workability: This describes the distribution and conduct of work in a division of labor. A complex intervention will affect the ways that work is defined and distributed (its allocation), and the ways in which it is undertaken and evaluated (its performance). Therefore: a complex intervention is disposed to normalization if is calibrated to an agreed skill-set at a recognizable location in the division of labor.
4. Contextual integration: This refers to the incorporation of work within an organization
al setting. A complex intervention will affect the mechanisms that link work to existing structures and procedures (its execution), and for allocating and organizing resources for them (its realization). Therefore: a complex intervention is disposed to normalization if it confers an advantage on an organization in flexibly executing and realizing work.
Grounded theory
Grounded theory is a systematic methodology in the social sciences involving the generation of theory from data. It is mainly used in qualitative research, but is also applicable to quantitative data....
in medical sociology
Medical sociology
Medical sociology is the sociological analysis of medical organizations and institutions; the production of knowledges and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural effects of medical practice...
and Science and Technology Studies
Science and technology studies
Science, technology and society is the study of how social, political, and cultural values affect scientific research and technological innovation, and how these, in turn, affect society, politics and culture...
(STS
STS
-Science, medicine, meteorology and technology:*Science and technology studies*Superior temporal sulcus*Socio-technical systems*Severe tropical storm*Scanning tunneling spectroscopy, a spectroscopy technique based on Scanning Tunneling Microscopy...
), based on qualitative methods. Carl May developed the model after he appeared as a witness at a British House of Commons
British House of Commons
The House of Commons is the lower house of the Parliament of the United Kingdom, which also comprises the Sovereign and the House of Lords . Both Commons and Lords meet in the Palace of Westminster. The Commons is a democratically elected body, consisting of 650 members , who are known as Members...
Health Committee Inquiry on New Medical Technologies in the NHS in 2005 . He asked how new technologies became routinely embedded, and taken-for-granted, in everyday work, in view of the increasing corporate organization
Organization
An organization is a social group which distributes tasks for a collective goal. The word itself is derived from the Greek word organon, itself derived from the better-known word ergon - as we know `organ` - and it means a compartment for a particular job.There are a variety of legal types of...
and regulation
Regulation
Regulation is administrative legislation that constitutes or constrains rights and allocates responsibilities. It can be distinguished from primary legislation on the one hand and judge-made law on the other...
of healthcare. The model explains embedding by looking at the work that people do to make it possible.
The model is a theory
Theory
The English word theory was derived from a technical term in Ancient Greek philosophy. The word theoria, , meant "a looking at, viewing, beholding", and referring to contemplation or speculation, as opposed to action...
in sociology that fits well with macro approaches to innovation
Innovation
Innovation is the creation of better or more effective products, processes, technologies, or ideas that are accepted by markets, governments, and society...
like the diffusion of innovations
Diffusion of innovations
Diffusion of Innovations is a theory that seeks to explain how, why, and at what rate new ideas and technology spread through cultures. Everett Rogers, a professor of rural sociology, popularized the theory in his 1962 book Diffusion of Innovations...
theory developed by Everett Rogers
Everett Rogers
Everett M. Rogers was a communication scholar, sociologist, writer, and teacher. He is best known for originating the diffusion of innovations theory and for introducing the term early adopter....
. Although the Normalization Process Model is limited in scope to healthcare settings recent work by May and colleagues has led to the development of Normalization Process Theory
Normalization Process Theory
Normalization process theory is a sociological theory of the implementation, embedding, and integration of new technologies and organizational innovations developed by Carl R. May, Tracey Finch, and others...
, which presents a general sociological theory of implementation and integration of technological and organizational innovations. Normalization Process Theory
Normalization Process Theory
Normalization process theory is a sociological theory of the implementation, embedding, and integration of new technologies and organizational innovations developed by Carl R. May, Tracey Finch, and others...
has now superseded the more limited Normalization Process Model.
The Normalization Process Model provides a framework for process evaluation and also for comparative studies of complex interventions, especially of randomized controlled trials. Clinical trials and other evaluations of healthcare interventions often focus on the complex relationships between actors, objects and contexts, making a simple explanatory model, that fits well with other frameworks a necessary tool for clinical and health service researchers. In the Normalization Process Model, A complex intervention is defined as a deliberately initiated attempt to introduce new, or modify existing, patterns of collective action in health care.
A complex intervention has three kinds of components :
1. Actors are the individuals and groups that encounter each other in health care settings. They can include physicians, other health professionals, managers, patients, and family members. The aims of interventions aimed at actors are often to change people’s behaviour and its intended outcomes.
2. Objects are the institutionally sanctioned means by which knowledge and practice are enacted. They can include procedures, protocols, hardware, and software The aims of interventions aimed at objects often include changing people’s expertise and actions.
3. Contexts are the physical, organisational, institutional, and legislative structures that enable and constrain, and resource and realize, people and procedures. The aims of interventions aimed at contexts are often to change the ways that people organize their work to achieve goals in health care (or other) services.
The normalization process model explains theembedding of complex interventions by reference to four constructs of collective action that are demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration)in a rigorous and sound theory .
1. Interactional workability: This describes how a complex intervention is operationalized by the people using it. A complex intervention will affect co-operative interactions over work (its congruence), and the normal pattern of outcomes of this work (its disposal). Therefore: a complex intervention is disposed to normalization if it confers an interactional advantage in flexibly accomplishing congruence and disposal of work.
2. Relational integration: This describes how knowledge and work is mediated and understood within the social networks of people around it. A complex intervention will affect not only the knowledge required by its users (its accountability), but also the ways that they understand the actions of people around them (its confidence). Therefore: a complex intervention is disposed to normalization if it equals or improves accountability and confidence within networks.
3. Skill-set workability: This describes the distribution and conduct of work in a division of labor. A complex intervention will affect the ways that work is defined and distributed (its allocation), and the ways in which it is undertaken and evaluated (its performance). Therefore: a complex intervention is disposed to normalization if is calibrated to an agreed skill-set at a recognizable location in the division of labor.
4. Contextual integration: This refers to the incorporation of work within an organization
Organization
An organization is a social group which distributes tasks for a collective goal. The word itself is derived from the Greek word organon, itself derived from the better-known word ergon - as we know `organ` - and it means a compartment for a particular job.There are a variety of legal types of...
al setting. A complex intervention will affect the mechanisms that link work to existing structures and procedures (its execution), and for allocating and organizing resources for them (its realization). Therefore: a complex intervention is disposed to normalization if it confers an advantage on an organization in flexibly executing and realizing work.