Development of a theory of implementation and integration: normalization process theory

Abstract

Background Theories are important tools in the social and clinical 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 undertook three tasks. (i) We derived a set of empirical generalizations from analysis of data collected in qualitative studies of healthcare work and organization. (ii) We developed an applied theoretical model through summative analysis of empirical generalizations. (iii) 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.

Conclusion 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 be sufficiently robust to merit formal testing.