Introduction to Normalization Process Theory

Introduction to Normalization Process Theory: rationale, structure, and function

Carl May & Tracy Finch

www.normalizationprocess.org

© The authors 2010/ contact [email protected]

rationale

why normalization process theory?

robust social science theories already explain individual differences in attitudes to new

technologies and practices (e.g. Theory of Planned Behavior)

the flow of innovations through social networks (e.g. Diffusion of Innovations Theory)

reciprocal interactions between people and artifacts (e.g. Actor Network Theory)

NPT offers an explanation of the work of implementation, embedding, and integration – focusing on the agentic contribution of individuals and groups.

NPT explains phenomena not well covered by existing theories.

definition

definition of normalization: the routine embedding of a classification, artefact, technique or organizational practice in everyday life

research question: how can those factors that promote or inhibit normalization be identified, conceptualized, and evaluated?

normalization process theory: aim

• to explain how practices are routinely embedded in their organizational and professional contexts

• to explain the routine embedding of practices by reference to the role of four generative mechanisms (coherence; cognitive participation; collective action; reflexive monitoring).

• to explain how the work, (individually and collective), of implementing practices requires continuous investment by participants in ensembles of action that carry forward in time and space.

normalization process theory: general propositions

• to understand the embedding of a practice we must look at what people actually do and how they work.

• practices become routinely embedded in social contexts as the result of people working, individually and collectively, to implement them.

• the work of implementation is operationalized through four generative mechanisms (coherence; cognitive participation; collective action; reflexive monitoring).

• the production and reproduction of a practice requires continuous investment by agents in ensembles of action that carry forward in time and space.

structure

the structure of NPT/defining constructs and constraints

NPT assumes four constructs representing generative mechanisms driven by investments of human agency. These are the means by which social goals are achieved and, in turn, are foci of contests and conflicts

NPT assumes that individual and collective contributions are interdependent

NPT mechanisms are constrained (and released) by the operation of norms (notions of how beliefs, behaviours, and actions should be accomplished); and conventions (how beliefs, behaviours, and actions are practically accomplished)

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

phenomena represented by NPT constructs appear simultaneously in relation to each other, not sequentially

all NPT constructs are not necessary to explain all phenomena

phenomena represented by NPT constructs are constrained by norms and convention

the structure of NPT/defining processes

‘process’ refers to patterns of organized, dynamic, and contingent interaction between: agents (the individuals or groups that

interact in encounters around a practice); objects (the classifications, artifacts,

practices and procedures employed by agents); and

contexts (the technical and organizational structures in which agents and objects are implicated).

NPT does not assume…

a normative expectation that a practice ought to be implemented and voluntarism on the part of agents

that a practice (or any of its components) is superior in performance to its alternatives or competitors

that normalization is a necessary or automatic outcome of an implementation-embedding-integration process

That normalization is a permanent state of affairs

CONSTRUCT A CONSTRUCT B CONSTRUCT C CONSTRUCT D

IMMEDIATE COMPONENTS

C3 & C4

ORGANIZING COMPONENTS

C1 & C2

CONSTRAINT: STRUCTURES & NORMS

CONSTRAINT: PROCESSES & CONVENTIONS

the structure of NPT/constructs, components, and constraints

construct/coherence

• coherence: defines and organizes the components of a practice

• what is the work? Differentiation, communal and individual specification, and internalization

coherence/components

differentiation defines a practice and organizes its relationships with other practices and contexts;

communal specification or co-ordination forms and organizes shared beliefs and knowledge about the purpose of the practice

individual specification forms and organizes personal beliefs and knowledge about the demands of the practice

internalization defines the value of the practice to its users.

COLLECTIVE ACTION

REFLEXIVE MONITORING

COHERENCE COGNITIVE PARTICIPATION


(Individual Specification & Internalization)


(Differentiation & Communal

Specification)

NORMATIVE CONSTRAINTS

PROCESSUAL CONSTRAINTS

coherence/analytic model

coherence/general propositions

embedding of a practice is dependent on work that defines and organizes it as a cognitive and behavioral ensemble.

embedding work is shaped by factors that promote or inhibit actors’ apprehension of a practice as meaningful.

the production and reproduction of a practice that actors collectively invest meaning in it.

construct/cognitive participation

• cognitive participation: Work that defines and organizes the people implicated in a practice

• what is the work? Initation, legitimation, enrolment and activation

cognitive participation/components

initiation brings a practice into practice legitimation forms and organizes shared

beliefs about the legitimacy of participating in a practice

enrolment forms and organizes the ways that participants join in a practice

activation forms and organizes the ways that participants continue to support a practice


COHERENCECOGNITIVE

PARTICIPATION COLLECTIVE ACTION

IMMEDIATE COMPONENTS(initiation and legitimation)

ORGANIZING COMPONENTS(enrolment and

activation)



cognitive participation/analytic model

cognitive participation/general propositions

embedding of a practice is dependent on work that defines and organizes its participants.

embedding work is shaped by factors that promote or inhibit participants’ involvement.

the production and reproduction of a practice requires that actors collectively invest commitment in it.

collective action/construct

• collective action: Work that defines and organizes the enacting of a complex intervention

• what is the work? Interaction work, relational integration, skill-set work, contextual integration

collective action/components

skill-set work of allocation and performance of the tasks related to a practice

relational integration in which confidence and accountability about a practice are formed and organised;

interactional work in which the practice is a vehicle for deciding and disposing of operational problems;

contextual integration in which material and interpersonal resources are realised and policies and procedures executed to support a practice

COHERENCE COGNITIVE PARTICIPATION

COLLECTIVE ACTION



(Interaction work & Relational

Integration)


(Skill set work & Contextual Integration)



collective action/analytic model

collective action/general propositions

embedding of a practice is dependent on work to operationalize it.

embedding work is shaped by factors that promote or inhibit actors’ enacting it.

the production and reproduction of a practice requires that actors collectively invest effort in it.

reflexive monitoring/construct

• reflexive monitoring: defines and organizes assessment of the outcomes of a practice

• what is the work? Systematization, communal and individual Appraisal, and reconfiguration

reflexive monitoring/components

systematizing forms and organises knowledge about the effects of a practice

communal appraisal people work together to assess whether the effects of a practice are worthwhile for others

individual appraisal people assess whether the effects of a practice are worthwhile for themselves

reconfiguration organizes changes in the ways that a practice is enacted

COGNITIVE PARTICIPATION

COLLECTIVE ACTION

REFLEXIVE MONITORING COHERENCE


(Individual Appraisal &

Reconfiguration)


(Systemization & Communal Appraisal)



reflexive monitoring/analytic model

reflexive monitoring/general propositions

embedding of a practice is dependent on work that defines and organizes the everyday understanding of its effects.

embedding work is shaped by factors that promote or inhibit individual and collective appraisal of the practice.

the production and reproduction of a practice requires that actors collectively invest in its understanding.

normalization process theory

can be used as a research and development tool to inform comparative investigations and

case studies using qualitative methods provide a conceptual framework for

explanatory systematic reviews suggest hypotheses for prospective

quantitative studies understand the outcomes of service

evaluations

this presentation summarizes four articles

May, C., and T. Finch. 2009. Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology 43: 535-54.May, C., F.S. Mair, T. Finch, A. et al. 2009. Development of a theory of implementation and integration: Normalization Process Theory. Implementation Science 4.May, C., T. Finch, F. Mair, et al. 2007. Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research 7.May, C. 2006. A rational model for assessing and evaluating complex interventions in health care. BMC Health Services Research 6: 1-11.

normalization process theory

This work was supported by the Economic and Social Research Council Grants RES 000270084 and 189250003

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Technology

Introduction to Normalization Process Theory