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. The theory is a contribution to the field of science and technology studies (STS), and is the result of a programme of theory building by May and his co-researchers, recently including Frances Mair, Glyn Elwyn and Victor Montori . The theory radically extended the Normalization Process Model previously developed by May et al. to explain the social processes that lead to the routine embedding of innovative health technologies.
May et al. have shown that normalization process theory pays attention to the ways that a material practice – which may be a new technique, technology, or pattern of organization – becomes routinely embedded in a social context as the result of individual and collective agency. This agency is operationalized through generative social mechanisms that are expressed through sense-making (coherence) work, engagement work (cognitive participation), the work of enacting a practice (collective action), and the work of understanding and appraising its effects. The theory is thus organized around understanding (and even measuring) social phenomena defined by four basic mechanisms:
- Coherence (or sense-making): expressed agency that defines and organizes the components of an implementation process.
- Cognitive participation: expressed agency that defines and organizes the actors involved in an implementation process.
- Collective action: expressed agency that defines and organizes the enacting of an implementation process.
- Reflexive monitoring: expressed agency that defines and organizes assessment of the outcomes of an implementation process.
Normalization Process Theory is a true middle range theory that is located within the 'turn to materiality' in STS. It therefore fits well with the case-study oriented approach to empirical investigation used in STS. It also appears to be a straightforward alternative to actor–network theory in that it does not insist on the agency of non-human actors, and seeks to be explanatory rather than descriptive. However, because Normalization Process Theory specifies a set of generative mechanisms that empirical investigation has shown to be relevant to implementation and integration of new technologies, it can also be used in larger scale structured and comparative studies. Although it fits well with the interpretive approach of ethnography and other qualitative research methods, it also lends itself to systematic review and survey research methods. As a middle range theory, it can be federated with other theories to explain empirical phenomena. It is compatible with theories of the transmission and organization of innovations, especially diffusion of innovations theory, labor process theory, and psychological theories including the theory of planned behavior and social learning theory.
- May, C., Finch, T., 2009. Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. In Press.
- May, C., Innovation and Implementation in Health Technology: Normalizing Telemedicine. In: J. Gabe, M. Calnan, Eds.), The New Sociology of the Health Service. Routledge, London, 2009.
- May, C., Mundane Medicine, Therapeutic Relationships, and the Clinical Encounter.’ In (eds.) In: B. Pescosolido, et al., Eds.), Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century. Springer, New York, 2009.
- May CR, Mair F, Finch T, Macfarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A, Murray E, Elwyn G, Légaré F, Gunn J, Montori VM. Development of a theory of implementation and integration: normalization process theory. Implement Sci. 2009 May 21;4:29.
- May, C., 2006. A rational model for assessing and evaluating complex interventions in health care. BMC Health Services Research. 6
- May, C., et al., 2007. Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research. 7.
- May C, Mair FS, Finch T, MacFarlane A, Dowrick C, Treweek S, et al. Development of a theory of implementation and integration: Normalization Process Theory. Implementation Science. 2009;4 art 29
- Gallacher K, May CR, Montori VM, Mair FS. Understanding patients' experiences of treatment burden in chronic heart failure using normalization process theory. Annals of Family Medicine 2011;14(4):351-360.
- Mair F, May C, O'Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inibit the implementation of e-health systems: an explanatory systematic review. Bulletin of the World Health Organisation 2012;90:357-364.
- Gallacher K, Jani B, Morrison D, Macdonald S, Blane D, Erwin P, May CR, Montori VM, Eton DT, Smith F, Batty DG, Mair FS. Qualitiative systematic reviews of treatment burden in stroke, heart failure, and diabetes - Methodological challenges and solutions. BMC Medical Research Methodology 2013;13(10).