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Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice

Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice
Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice
Background: decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.

Methods: the Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.

Results: conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.

Conclusion: the model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacted
57-[9pp]
Elwyn, Glyn
dd0ada9e-9b87-4734-9f9c-9a914d5e200a
Légaré, France
12c7505b-0d78-4c52-8f6e-9e337e5af8df
Weijden, Trudy
dafc0237-4785-44f1-9bd2-716b6f8260fe
Edwards, Adrian
48b48c65-beeb-4a70-bd63-ad6186e79708
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Elwyn, Glyn
dd0ada9e-9b87-4734-9f9c-9a914d5e200a
Légaré, France
12c7505b-0d78-4c52-8f6e-9e337e5af8df
Weijden, Trudy
dafc0237-4785-44f1-9bd2-716b6f8260fe
Edwards, Adrian
48b48c65-beeb-4a70-bd63-ad6186e79708
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4

Elwyn, Glyn, Légaré, France, Weijden, Trudy, Edwards, Adrian and May, Carl (2008) Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice. Implementation Science, 3 (1), 57-[9pp]. (doi:10.1186/1748-5908-3-57).

Record type: Article

Abstract

Background: decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.

Methods: the Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.

Results: conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.

Conclusion: the model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacted

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Published date: December 2008

Identifiers

Local EPrints ID: 163593
URI: https://eprints.soton.ac.uk/id/eprint/163593
PURE UUID: 98e4e9f1-5661-4143-8443-df945bc03c5e
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690

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Date deposited: 09 Sep 2010 14:09
Last modified: 03 Dec 2019 01:41

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Contributors

Author: Glyn Elwyn
Author: France Légaré
Author: Trudy Weijden
Author: Adrian Edwards
Author: Carl May ORCID iD

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