Smoothing the way for practice change

Journal Clubs are becoming popular as a way for teams to look together at research evidence and decide if practice needs to change as a result. But do we give enough thought to what happens next? Introducing and getting familiar with using a new practice / intervention (or adapting or stopping use of an existing one) takes a lot of work. Paying more attention to implementation might benefit our clients if it leads to us changing our practice more quickly and effectively.

Mulling over an idea before you do anything about it, both on your own and together with other people, is part of making it happen. One of the most useful frameworks I have found for thinking through implementation is Normalisation Process Theory. Unfortunately, while the theory itself is very practical, the wording is too complicated to make this immediately obvious. So, with some trepidation but in the spirit of speech and language therapy, here is my first attempt at an accessible version. (Although I have adapted it from table 1 in Mair et al., 2012, I take full responsibility for any misinterpretation of the original theory!) You will need to amend the questions depending on the ‘thing’ you are discussing, whether you are intending to implement or de-implement it, and to take account of the opinions of all the groups who need to be involved (e.g. clients, user representatives, other professionals).

Normalisation Process Theory is organised into 4 sections, each of which has 4 sub-sections. I have phrased all of these as questions for discussion, and it would be pointless to treat it as a tick-box list. Although there will always be overlap, each sub-section offers a slightly different perspective. This may highlight tensions between members of your team, or between your team and other groups of people, and help you decide where to focus your efforts.

Section 1: Does the new practice make sense?

a) How is the new practice different from what we are doing already?

b) What difference can we expect it to make?

c) What would each of us need to do to get it to happen?

d) What makes the new practice important?

Section 2: Do we want to make the change?

a) Does everyone agree it is a good idea to do this?

b) Are we able and willing to persist with it?

c) Do any of us want to take a lead in showing how it can be done?

d) Do we think it’s right for us to be doing this?

Section 3: How will we go about it? 

a) Will this change have an impact on our roles or responsibilities, and what training will be needed?

b) Will we have any support from our organisation to make the change happen?

c) Could the new practice make our job easier in any way?

d) Are we confident that the new practice will work?

Section 4: How will we know it’s been worth doing?

a) How will we collect information about any adaptations we make?

b) How will we find out what other people (e.g. clients) think of the new practice?

c) How will we collect and use information about how the new practice has affected us and our work environment?

d) How will we measure benefits or problems resulting from the new practice?

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