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

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  • May, Carl

Abstract

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.

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  • 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

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    4. Mark Jeffries & Richard N Keers & Denham L Phipps & Richard Williams & Benjamin Brown & Anthony J Avery & Niels Peek & Darren M Ashcroft, 2018. "Developing a learning health system: Insights from a qualitative process evaluation of a pharmacist-led electronic audit and feedback intervention to improve medication safety in primary care," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-16, October.
    5. 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.
    6. Macabasag, Romeo Luis A. & Mallari, Eunice U. & Pascual, Patrick Joshua C. & Fernandez-Marcelo, Portia Grace H., 2022. "Normalisation of electronic medical records in routine healthcare work amidst ongoing digitalisation of the Philippine health system," Social Science & Medicine, Elsevier, vol. 307(C).
    7. Mauldin, Laura, 2019. "Don't look at it as a miracle cure: Contested notions of success and failure in family narratives of pediatric cochlear implantation," Social Science & Medicine, Elsevier, vol. 228(C), pages 117-125.
    8. 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.
    9. Davina Allen & Carl May, 2017. "Organizing Practice and Practicing Organization: An Outline of Translational Mobilization Theory," SAGE Open, , vol. 7(2), pages 21582440177, June.
    10. 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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