Implementation Science and Normalization Process Theory (NPT) Workshop
Updated: Oct 21, 2019
I was fortunate to be able to attend this workshop on September 3 and 4.
This workshop was lead by Carl May FAcSS, a British sociologist. He researches in the fields of medical sociology and science and technology studies. Formerly based at Southampton University and Newcastle University, he is now Professor of Medical Sociology at the London School of Hygiene and Tropical Medicine.
One of the primary claims of implementation science is that the combination of relevant theory and rigorous research methods will lead to improvements in our capacity to engineer the effective transformation of healthcare practices and systems. A change to healthcare practices and systems is our vision for Tele-Rehab 2.0. However, the current pilot project did not fit in with the other projects at the workshop because of the technology development component. Nobody else in the room was involved in creating new health techniques or technologies; they were just responsible for getting people to use them. At this point, we are not as concerned with implementation as much as we are on showing the proof-of-concept. This was an important distinction and helped frame my perspective throughout the workshop.
This workshop focused on Normalization Process Theory and Collective Impact Framework. It was beneficial to understand a bit more about how changes are introduced to the healthcare system and methods that help structure that work. After doing a bit of research, I realized that the Tele-Rehab 2.0 project was developed based on the Innovation Learning Collaborative Approach from the Strategic Clinical Network (SCN). This means we already had many key elements of implementation integrated within the project design (ex. community engagement, co-creation, and collaboration).
It was a lot of information to process, so it helped me to consider a few specific examples.
Theories, frameworks, tools:
Normalization process theory- A way of looking at the dynamic and collective work and relationships involved in the implementation and social shaping of practices. This is helpful for understanding how, over time, new practices such as remote rehab could be implemented, embedded, and integrated into the Alberta healthcare system.
Collective impact framework - This approach requires the commitment of a group of actors from different sectors to a common agenda for solving a specific social problem, using a structured form of collaboration. It contains five core conditions including the development of a common agenda; using shared measurement to understand progress; building on mutually reinforcing activities; engaging in continuous communications and providing a backbone to move the work forward.
Innovation Learning Collaborative Approach - This approach was developed within the Strategic Clinical Networks (SCNs) to implement clinical best practice and achieve system-wide improvements. This method involves learning sessions, action periods, balanced scorecards, measurement and results, sustainability.
PDSA tool, itFits toolkit - The tools support activities within the framework or approach. I spoke with Carl about the relationship between leadership and implementation science and his thoughts were that "leaders are there to focus and facilitate collective action and collaboration." The theories, frameworks, and tools of implementation science are there to help leaders organize their approach to solving a complex problem.
I like the structure and organization that these things provide, and they give a bigger picture view of how the implementation process works. This would not necessarily change what we are doing, and especially not at the front lines of our technology development or storyboard trials. However, it could help to organize our thoughts about what we are doing, why we are doing it, and also to support evaluation of the project once it is done.
Overall, it was worthwhile to attend this workshop to learn about implementation science even if that is not the focus of our project. The proof-of-concept that we are completing in Tele-Rehab 2.0 will show, first and foremost, that the technology and process for remote assessment works. If it does, then the implementation of this new practice into the Alberta healthcare system would then follow. Knowing about these theories and methods will be helpful as we are looking towards the end of our funding period and spread and scale.