Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice
Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice
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DOI：
10.1186/1748-5908-3-57
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发表时间：
2008-12-31
影响因子：
7.2
通讯作者：
May, Carl
中科院分区：
文献类型：
--
作者：
Elwyn, Glyn;Legare, France;May, Carl
背景：决策支持技术（DST，也称为决策辅助）帮助患者和专业人员参与协作决策过程。试验表明，它对患者的知识、满意度、决策冲突和信心有积极的影响。然而，它们尚未常规地融入医疗保健环境中。很少有研究使用理论框架来解决这个问题。我们使用标准化过程模型解释了实施 DST 的问题，该模型是一个概念模型，重点关注复杂的干预措施如何定期嵌入实践中。方法：标准化过程模型被用作对先前初步研究和评论的结果进行概念分析的基础。使用虚拟工作环境，我们应用该模型及其主要概念来检查： DST 在专业患者互动中的“可操作性”； DST 如何影响用户之间的知识关系； DST 如何影响用户的技能和表现；以及 DST 对组织资源分配的影响。结果：使用规范化过程模型进行的概念分析提供了对日常环境中 DST 实施问题的见解。目前的研究主要集中在这些技术的交互可操作性上，但对与分工和医疗保健相关的因素以及使用数字服务技术的组织环境的描述和理解很少。结论：该模型成功地提供了一个框架，帮助识别促进和抑制医疗保健领域实施数字服务技术的因素，并使我们深入了解影响在权力和知识不对称的谈判环境中引入新技术的因素。未来关于数字存储技术部署的研究和开发需要采取更全面的方法，并重点关注这些技术得以实施的结构条件和社会规范。
Background: Decision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.Methods: The Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.Results: A conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.Conclusion: The model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacted.