Normalization Process Theory


Everyone is interested in innovation in healthcare. Innovation promises better ways of organizing and delivering treatment, improvements in the clinical and cost-effectiveness of services, and reductions in the burdens of illness - especially chronic illness. Most research on healthcare innovation focuses on the outcomes of innovations - measuring their impact and exploring their effects - but this doesn't always tell us the things that we need to know.  Researchers try to help healthcare providers by quantifying outcomes and comparing the effects of these innovations.  But it is also understood that outcomes evaluations are not enough, and that we need to perform process evaluations that help us to understand how these effects come about.

Identifying and adopting an innovative health technology, or a new way of organizing professional work, is the beginning of the story, not the end.  Down the line, policy-makers, managers, professionals, and patients all face two important problems as they try to get innovations into practice.

  • Process problems: about the implementation of new ways of thinking, acting and organizing in health care
  • Structural problems: about the integration of new systems of practice into existing organizational and professional settings.

These are important problems for researchers and evaluators too. To understand implementation and integration, we need focus on the dynamic processes that lead to innovations becoming embedded in everyday work.  Normalization Process Theory is an explanatory model that helps managers, clinicians, and researchers understand these processes.

Normalization Process Theory work is led by Carl May at the University of Southampton.  The Normalization A useful paper on using Normalisation Process Theory is available at  Further details are available at


Shaun Treweek;