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Agency and implementation: Understanding the embedding of healthcare innovations in practice


  • May, Carl


An innovation is almost never a thing-in-itself. To be sure, there is often what looks like a thing – a newly invented or modified way of thinking or acting, or an artifact, or a system – that is identified in everyday talk as something new. In healthcare, as in almost every other area of human organization, innovations often involve highly organized, institutionally sanctioned, and systematically regulated changes in the structure and delivery of services. This paper presents a theory of implementation and embedding of innovations – Normalization Process Theory – and explores its application to a highly complex ensemble of socio-technical practices, clinical shared decision making. The theoretical analysis presented here shows how implementation as a process and embedding as a state can be conceptualized in terms of social mechanisms that effect changes in the ways that agents' contribute to normative restructuring, the reworking of relational conventions and group processes, the enacting of practices, and their projection into the future.

Suggested Citation

  • May, Carl, 2013. "Agency and implementation: Understanding the embedding of healthcare innovations in practice," Social Science & Medicine, Elsevier, vol. 78(C), pages 26-33.
  • Handle: RePEc:eee:socmed:v:78:y:2013:i:c:p:26-33
    DOI: 10.1016/j.socscimed.2012.11.021

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    References listed on IDEAS

    1. Sinding, Christina & Hudak, Pamela & Wiernikowski, Jennifer & Aronson, Jane & Miller, Pat & Gould, Judy & Fitzpatrick-Lewis, Donna, 2010. ""I like to be an informed person but..." negotiating responsibility for treatment decisions in cancer care," Social Science & Medicine, Elsevier, vol. 71(6), pages 1094-1101, September.
    2. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    3. Nicolini, Davide, 2006. "The work to make telemedicine work: A social and articulative view," Social Science & Medicine, Elsevier, vol. 62(11), pages 2754-2767, June.
    4. Greenhalgh, Trisha & Stones, Rob, 2010. "Theorising big IT programmes in healthcare: Strong structuration theory meets actor-network theory," Social Science & Medicine, Elsevier, vol. 70(9), pages 1285-1294, May.
    5. May, Carl & Rapley, Tim & Moreira, Tiago & Finch, Tracy & Heaven, Ben, 2006. "Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine," Social Science & Medicine, Elsevier, vol. 62(4), pages 1022-1030, February.
    6. Rapley, Tim & May, Carl & Heaven, Ben & Murtagh, Madeline & Graham, Ruth & Kaner, Eileen F.S. & Thomson, Richard, 2006. "Doctor-patient interaction in a randomised controlled trial of decision-support tools," Social Science & Medicine, Elsevier, vol. 62(9), pages 2267-2278, May.
    7. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
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    Cited by:

    1. Maniatopoulos, Gregory & Procter, Rob & Llewellyn, Sue & Harvey, Gill & Boyd, Alan, 2015. "Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology," Social Science & Medicine, Elsevier, vol. 131(C), pages 98-106.
    2. Andreassen, Hege K. & Kjekshus, Lars Erik & Tjora, Aksel, 2015. "Survival of the project: A case study of ICT innovation in health care," Social Science & Medicine, Elsevier, vol. 132(C), pages 62-69.
    3. Hawe, Penelope & Riley, Therese & Gartrell, Alexandra & Turner, Karen & Canales, Claudia & Omstead, Darlene, 2015. "Comparison communities in a cluster randomised trial innovate in response to ‘being controlled’," Social Science & Medicine, Elsevier, vol. 133(C), pages 102-110.
    4. Janssen, M. & Stoopendaal, A.M.V. & Putters, K., 2015. "Situated novelty: Introducing a process perspective on the study of innovation," Research Policy, Elsevier, vol. 44(10), pages 1974-1984.


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