Bracher Mike, May Carl R
School of Health Sciences, University of Southampton, Southampton, UK.
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
Stud Health Technol Inform. 2019 Jul 30;263:171-190. doi: 10.3233/SHTI190121.
Successful implementation of health informatics systems depends not only on efficient performance of intended tasks, but also integration into existing working relationships and environments. Implementation is an understudied area in health informatics research, and relevant empirical evidence is often absent from strategic decision making. Implementation theories such as Normalization Process Theory (NPT) can help address this gap by providing explanations for relevant phenomena, proposing important research questions, and framing collection and analysis of data. NPT identifies, characterizes, and explains mechanisms that have been empirically demonstrated to affect implementation processes and outcomes. These explanations are generalizable and facilitate comparative investigations. The first section of this chapter introduces the four main constructs of NPT (coherence, cognitive participation, collective action, and reflexive monitoring) and their constituent components. Each component is discussed with reference to a real-world example, and relationships between the four constructs are explored. The second section explores how NPT has been applied in both prospective planning of interventions and their evaluation, as well as retrospective exploration of factors promoting or inhibiting successful implementation. We examine two examples from published literature: firstly, prospective planning of an evaluation study on implementation of a digital health intervention for Type-2 diabetes; and secondly an evaluation of implementation of a new electronic preoperative information system within a surgical pre-assessment clinic. The chapter concludes with reflections on some limitations of NPT as a theoretical framework.
健康信息学系统的成功实施不仅取决于预期任务的高效执行，还取决于融入现有的工作关系和环境。实施是健康信息学研究中一个研究不足的领域，战略决策中往往缺乏相关的实证证据。诸如规范化过程理论（NPT）等实施理论可以通过对相关现象提供解释、提出重要研究问题以及构建数据收集和分析框架来帮助弥补这一差距。NPT识别、描述并解释了经实证证明会影响实施过程和结果的机制。这些解释具有普遍性，便于进行比较研究。本章第一节介绍了NPT的四个主要构成要素（连贯性、认知参与、集体行动和反思性监测）及其组成部分。每个组成部分都结合一个实际例子进行讨论，并探讨这四个构成要素之间的关系。第二节探讨了NPT如何应用于干预措施的前瞻性规划及其评估，以及对促进或抑制成功实施的因素进行回顾性探究。我们研究已发表文献中的两个例子：第一，对一项2型糖尿病数字健康干预措施实施情况的评估研究的前瞻性规划；第二，对一家外科术前评估诊所内一个新的电子术前信息系统实施情况的评估。本章最后对NPT作为一个理论框架的一些局限性进行了反思。
