title: Development of a theory of implementation and integration: Normalization Process Theory.
abstract: BACKGROUND
  Theories are important tools in the social and natural sciences. The methods by which they are derived are rarely described and discussed. Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes. This paper describes the process by which it was built.
  
  
  METHODS
  Between 1998 and 2008, we developed a theory. We derived a set of empirical generalizations from analysis of data collected in qualitative studies of healthcare work and organization. We developed an applied theoretical model through analysis of empirical generalizations. Finally, we built a formal theory through a process of extension and implication analysis of the applied theoretical model.
  
  
  RESULTS
  Each phase of theory development showed that the constructs of the theory did not conflict with each other, had explanatory power, and possessed sufficient robustness for formal testing. As the theory developed, its scope expanded from a set of observed regularities in data with procedural explanations, to an applied theoretical model, to a formal middle-range theory.
  
  
  CONCLUSIONS
  Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development. The theory has been shown to merit formal testing.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle, UK. c.r.may@ncl.ac.uk
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
authors.forename: Frances
authors.initials: F
authors.lastname: Mair
authors.forename: Tracy
authors.initials: T
authors.lastname: Finch
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.forename: Tim
authors.initials: T
authors.lastname: Rapley
authors.forename: Luciana
authors.initials: L
authors.lastname: Ballini
authors.forename: Bie Nio
authors.initials: BN
authors.lastname: Ong
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Elizabeth
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authors.lastname: Murray
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: France
authors.initials: F
authors.lastname: Légaré
authors.forename: Jane
authors.initials: J
authors.lastname: Gunn
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori