Seite - 172 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

1. Introduction to Normalization Process Theory (NPT) ‘Implementation theories are useful. They provide explanations for relevant phenomena, propose important research questions, and frame the collection and analysis of data. These explanations are generalizable, and facilitate comparative studies. Implementation researchers now have a wide range of useful theoretical tools at their disposal…Normalization Process Theory (NPT), is one of these. It identifies, characterizes and explains mechanisms that have been empirically demonstrated to motivate and shape implementation processes and affect their outcomes.’ [1] Why are new technologies and working practices implemented successfully in some settings, but not in others? What affects whether a new technology or practice will be implemented in the first place, and whether it will ‘stick’ in the longer term (that is, become incorporated into routine work within an organization)? NPT has developed from empirical attempts to answer such questions2. In this first section, we will explore the theory in terms of its main constructs and their components, to understand how NPT provides a framework for understanding implementation3. 1.1 Understanding implementation as a set of processes NPT focuses on action (both individual and social) - that is, what people do, rather than what they say or think – and on the processes through which these actions take shape. NPT is grounded in the premise that implementation of an e-health or informatics application involves human actors infour things: (i) changes in goal-directed interactions with material and virtual things (physical infrastructure, hardware and software); (ii) relational restructuring (changes in the experience and organization of human relations); (iii) normative restructuring (changes in the rules and resources that make action possible); and (iv) organizing logics (changes in the ways that whole systems are defined and understood). From these stem specific kinds of work and it is from these that implementation processes are derived[2].These are: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. Each construct has four sub-components, which set out more specific kinds of work that occur within each domain. The remainder of this section will describe these elements and their relationship within the overall framework (readers may also view the Appendix which illustrates the relationship between constructs and their components as tables). 1.2 Making sense of new technologies and practices (Coherence). Coherence relates to ‘the sense-making work that people do individually and collectively when they are faced with the problem of operationalizing some set of practices’[3].Sense making is the work that people do to understandthat the intervention and its associated practices. 2 Readers wishing to further explore the history and context of NPT development may refer to the ‘Background’ section of May et al.’s (2018) systematic review of NPT use in feasibility studies and process evaluations [1], 3 This chapter will not discuss relations between NPT and other theories of implementation or organizational and/or behavioural change, as it is beyond the scope of thearticle. Readers interested in further comparative exploration of NPT in relation to other such theories may refer Moullin et al.’s (2015) systematic review of implementation frameworks relating to innovations in healthcare [16]. M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems172