A rational model for assessing and evaluating complex interventions in health care.
BACKGROUND
Understanding how new clinical techniques, technologies and other complex interventions become normalized in practice is important to researchers, clinicians, health service managers and policy-makers. This paper presents a model of the normalization of complex interventions.


METHODS
Between 1995 and 2005 multiple qualitative studies were undertaken. These examined: professional-patient relationships; changing patterns of care; the development, evaluation and implementation of telemedicine and related informatics systems; and the production and utilization of evidence for practice. Data from these studies were subjected to (i) formative re-analysis, leading to sets of analytic propositions; and to (ii) a summative analysis that aimed to build a robust conceptual model of the normalization of complex interventions in health care.


RESULTS
A normalization process model that enables analysis of the conditions necessary to support the introduction of complex interventions is presented. The model is defined by four constructs: interactional workability; relational integration; skill set workability and contextual integration. This model can be used to understand the normalization potential of new techniques and technologies in healthcare settings


CONCLUSIONS
The normalization process model has face validity in (i) assessing the potential for complex interventions to become routinely embedded in everyday clinical work, and (ii) evaluating the factors that promote or inhibit their success and failure in practice.
May
Carl
C
Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK. c.r.may@ncl.ac.uk
D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000523:psychology / Q000628:therapy; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D036301:Qualitative Research; D015203:Reproducibility of Results; D012962:Sociology, Medical; D013597:Systems Analysis; D013673:Technology Assessment, Biomedical / Q000379:methods*; D017216:Telemedicine; D006113:United Kingdom