MacFarlane, Anne
…I am signed up without any pain or hassle – an IT first for me!
Anne
Anne MacFarlane, Ph.D
Lecturer in Primary Care
Department of General Practice
No. 1 Distillery Road
National University of Ireland, Galway
Tel: ++ 353 91 495194
Fax: ++ 353 91 495558
e-mail anne.ma...@nuigalway.ie
MacFarlane, Anne
Hello all from a rainy Galway! As Carl mentioned, we have had a bit of correspondence about the distinction between the constructs of the NPM as processes and qualities. This is the e-mail I sent Carl earlier today with my thoughts. Looking forward to yours….
Morning Carl, thanks for this. As ever, stimulating to think about this….
I like the new attention to processes involved in normalization and the qualities of the ‘thing’ itself. My understanding of this distinction would be that the work that e.g. patients and professionals do to communicate with each other via video conferencing is a process of work. Their satisfaction/acceptance of this work and the extent to which it becomes routine for them would indicate the likelihood that the specific complex intervention has the ‘quality’ of high or low interactional workability….Correct?
However, I find I have questions about the terms suggested for process and I imagine that
(a this is because they have arisen from extensive discussions at your meeting and are based on shared understanding of those at the meeting (and I wasn’t there!)
(b there is no manual (yet!) to explain and unpack the terms further to wider audiences
The questions I would ask of these terms are as follows:
‘operationalisation’ of what? Operationalisation is a broad term that could potentially refer to operationalisation of the whole of a planned complex intervention. What is its specific meaning here and how does it relate to issues of the interaction, communication, agreements about ease of these issues?
Mediation…guess this would be about mediation of knowledge and practice about existing workflows and relationships, negotiations around who has knowledge for what and how it is to be used and so on.
Distribution…okay, this one is easier too, distribution of labour within a network of actors
Incorporation…the link between this term and my understanding of contextual integration isn’t clear. Is this about incorporation of a complex intervention into a whole organization? What is the value of using incorporation rather than ‘integration’?
To sum up: the idea of distingushing between processes and qualities is great. The terms suggested to describe processes seem to me to add a layer of ‘complication’ that the model does not need if it is to be used by wider audiences.
Could the process terms be extended to describe the work that is undertaken in the process of achieving the 4 qualities?
Could the terminology be taken from the current draft of the BIomed central paper to ensure consistency and avoid adding more terminology that is potentially hard for others to decipher?
So e.g. BioMed Central paper Version 009, page 16, Box 3 ‘Propositions about endogenous factors of the model’ pt 1 re interactional workability reads ‘how does a complex intervention affect the interaction between patients and professionals and professionals and professionals?’
Could this be adapted further to the present purpose of describing the process leading to the quality of interactional workability along the lines of:
Work undertaken by professionals and patients to interact with each other in an agreed manner….???
Finally, thanks for setting up the mailing list. It’s a great idea.
All the best,
Anne
From: C R May
[mailto:c.r...@newcastle.ac.uk]
Sent: 22 May 2007 20:09
To: Tracy
Finch; Frances Mair; Ballini Luciana; Dowrick, Christopher; Martin Eccles; MacFarlane,
Anne; elizabet...@pcps.ucl.ac.uk;
Tim Rapley; anne....@manchester.ac.uk;
Shaun Treweek; elw...@cardiff.ac.uk; France Legare;
France...@mfa.ulaval.ca; Janice Osbourne; Jo Burns; Lisa....@ed.ac.uk;
Karen Fairhurst; Kate O'Donnell; linda...@manchester.ac.uk;
ga...@clinmed.gla.ac.uk; Ben Heaven;
ber...@googlemail.com
Subject: Normalization Process
Model - naming of parts
Colleagues
At the risk of taxing your patience, I'd be interested in your thoughts about
something that has been troubling me about this model. This is a problem that
is evident in the empirical work going on now that uses the model and refers to
the status of the four factors. Put simply it is this. These four factors
(interactional and skill set workability, and relational and contextual
integration) are spoken about in two quite different ways.
(a) They refer to the work through which the normalization of a complex
intervention might be accomplished. They qualitatively describe a set of
complex and emergent human activities that mediate between a complex
intervention and its interpersonal and structural contexts. Normalization is
thus explained by reference to social processes - by work invested in
contextual integration for example.
(b) They refer to complex interventions, or activities related to
them, as things-in-themselves. They define observable or measurable
characteristics of a complex intervention and the potential of it to
normalize might therefore be regarded as quantifiable - for example, acheiving a
normalization process quotient greater than 3.5 (to pull a number out of the
air) would do it.
This problem has arisen because the names given to the four factors do imply
that they are qualities of a thing rather than elements of a process. We spoke
about this today at some length during an Ehealth Implementation Project
meeting here at Newcastle,
and we felt we could deal with the problem by giving processes
and qualities different names, thus:
|
Process |
Quality |
|
Operationalization |
Interactional workability |
|
Mediation |
Relational integration |
|
Distribution |
Skill set workability |
|
Incorporation |
Contextual integration |
|
|
|
If we can collectively agree this, or something like it, then the model can stabilize itself in practice a bit. But it seems sensible to deal with it before any of the papers currently in process are finalized, and it is important for Tracy, Jo, Lisa, George and others who are doing field research using the model that this is resolved in a way that is satisfactory in practice as well as for publications already in train. This requires a consensus that it is the right thing to do. Please let me know what you think, but perhaps it would be best to resist pressing 'reply all'!
I'm in the process of setting up a mailbase list for the Model which will mean an end to these ad hoc emails. Thanks for your patience.
Best, carl
Professor
Carl May
Institute of Health and Society
Newcastle University
21 Claremont Place
Newcastle upon Tyne
NE2 4AA
United Kingdom
www.ncl.ac.uk/ihs/research/healthhuman/
Tel + 44 (0)191 222 5591
Fax + 44 (0) 191 222 6043
Email c.r...@ncl.ac.uk
Shaun Treweek
Hello all from a rainy Galway! As Carl mentioned, we have had a bit of correspondence about the distinction between the constructs of the NPM as processes and qualities. This is the e-mail I sent Carl earlier today with my thoughts. Looking forward to yours....
Morning Carl, thanks for this. As ever, stimulating to think about this....
I like the new attention to processes involved in normalization and the qualities of the 'thing' itself. My understanding of this distinction would be that the work that e.g. patients and professionals do to communicate with each other via video conferencing is a process of work. Their satisfaction/acceptance of this work and the extent to which it becomes routine for them would indicate the likelihood that the specific complex intervention has the 'quality' of high or low interactional workability....Correct?
However, I find I have questions about the terms suggested for process and I imagine that
(a this is because they have arisen from extensive discussions at your meeting and are based on shared understanding of those at the meeting (and I wasn't there!)
(b there is no manual (yet!) to explain and unpack the terms further to wider audiences
The questions I would ask of these terms are as follows:
'operationalisation' of what? Operationalisation is a broad term that could potentially refer to operationalisation of the whole of a planned complex intervention. What is its specific meaning here and how does it relate to issues of the interaction, communication, agreements about ease of these issues?
Mediation...guess this would be about mediation of knowledge and practice about existing workflows and relationships, negotiations around who has knowledge for what and how it is to be used and so on.
Distribution...okay, this one is easier too, distribution of labour within a network of actors
Incorporation...the link between this term and my understanding of contextual integration isn't clear. Is this about incorporation of a complex intervention into a whole organization? What is the value of using incorporation rather than 'integration'?
To sum up: the idea of distingushing between processes and qualities is great. The terms suggested to describe processes seem to me to add a layer of 'complication' that the model does not need if it is to be used by wider audiences.
Could the process terms be extended to describe the work that is undertaken in the process of achieving the 4 qualities?
Could the terminology be taken from the current draft of the BIomed central paper to ensure consistency and avoid adding more terminology that is potentially hard for others to decipher?
So e.g. BioMed Central paper Version 009, page 16, Box 3 'Propositions about endogenous factors of the model' pt 1 re interactional workability reads 'how does a complex intervention affect the interaction between patients and professionals and professionals and professionals?'
Could this be adapted further to the present purpose of describing the process leading to the quality of interactional workability along the lines of:
Work undertaken by professionals and patients to interact with each other in an agreed manner....???
Finally, thanks for setting up the mailing list. It's a great idea.
All the best,
Anne
From: C R May [mailto:c.r...@newcastle.ac.uk]
Sent: 22 May 2007 20:09
To: Tracy Finch; Frances Mair; Ballini Luciana; Dowrick, Christopher; Martin Eccles; MacFarlane, Anne; elizabet...@pcps.ucl.ac.uk; Tim Rapley;anne....@manchester.ac.uk; Shaun Treweek; elw...@cardiff.ac.uk; France Legare; France...@mfa.ulaval.ca; Janice Osbourne; Jo Burns; Lisa....@ed.ac.uk; Karen Fairhurst; Kate O'Donnell; linda...@manchester.ac.uk; ga...@clinmed.gla.ac.uk; Ben Heaven; ber...@googlemail.com
Subject: Normalization Process Model - naming of parts
Colleagues
At the risk of taxing your patience, I'd be interested in your thoughts about something that has been troubling me about this model. This is a problem that is evident in the empirical work going on now that uses the model and refers to the status of the four factors. Put simply it is this. These four factors (interactional and skill set workability, and relational and contextual integration) are spoken about in two quite different ways.
(a) They refer to the work through which the normalization of a complex intervention might be accomplished. They qualitatively describe a set of complex and emergent human activities that mediate between a complex intervention and its interpersonal and structural contexts. Normalization is thus explained by reference to social processes - by work invested in contextual integration for example.
(b) They refer to complex interventions, or activities related to them, as things-in-themselves. They define observable or measurable characteristics of a complex intervention and the potential of it to normalize might therefore be regarded as quantifiable - for example, acheiving a normalization process quotient greater than 3.5 (to pull a number out of the air) would do it.
This problem has arisen because the names given to the four factors do imply that they are qualities of a thing rather than elements of a process. We spoke about this today at some length during an Ehealth Implementation Project meeting here atNewcastle, and we felt we could deal with the problem by giving processes and qualities different names, thus:
C R May
Folks
Thanks to Shaun, Glyn, Anne, Frances, Luciana, Tim for their thoughtful
comments on this question. The growing consensus is that we should leave
the constructs as they are - and not divide between process and quality.
We may revisit this down the line when we have the papers from the first
wave of empirical studies. That won't be long, I suspect.
How are people finding the newsgroup as a way of woprking through these
questions? Is it working for you?
Best, Carl
Professor Carl May
Institute of Health and Society
Newcastle University
21 Claremont Place
Newcastle upon Tyne
NE2 4AA
United Kingdom
www.ncl.ac.uk/ihs/research/healthhuman/
Tel + 44 (0)191 222 5591
Fax + 44 (0) 191 222 6043
Email c.r...@ncl.ac.uk
__________________
Shaun Treweek
The newsgroup works fine for me; I like the fact that all the
discussions are in one place. I've just noticed that I can't upload
documents using my normal (Mac) browser but I can switch to another
browser should I need to do that.
Cheers,
Shaun
On May 28, 5:14 pm, "C R May" <c.r....@newcastle.ac.uk> wrote:
> Folks
>
> Thanks to Shaun, Glyn, Anne, Frances, Luciana, Tim for their thoughtful
> comments on this question. The growing consensus is that we should leave
> the constructs as they are - and not divide between process and quality.
> We may revisit this down the line when we have the papers from the first
> wave of empirical studies. That won't be long, I suspect.
>
> How are people finding the newsgroup as a way of woprking through these
> questions? Is it working for you?
>
> Best, Carl
>
> Professor Carl May
> Institute of Health and Society
> Newcastle University
> 21 Claremont Place
> Newcastle upon Tyne
> NE2 4AA
> United Kingdom
>
> www.ncl.ac.uk/ihs/research/healthhuman/
>
> Tel + 44 (0)191 222 5591
> Fax + 44 (0) 191 222 6043
> Email c.r....@ncl.ac.uk
> Email: strew...@mac.com
> From: C R May [mailto:c.r....@newcastle.ac.uk]
> Sent: 22 May 2007 20:09
> To: Tracy Finch; Frances Mair; Ballini Luciana; Dowrick,
> Christopher; Martin Eccles; MacFarlane, Anne;
> elizabeth.mur...@pcps.ucl.ac.uk; Tim
> Rapley;anne.rog...@manchester.ac.uk; Shaun Treweek;
> elw...@cardiff.ac.uk; France Legare; France.Leg...@mfa.ulaval.ca; Janice
> Osbourne; Jo Burns; Lisa.Ha...@ed.ac.uk; Karen Fairhurst; Kate
> O'Donnell; linda.g...@manchester.ac.uk; g...@clinmed.gla.ac.uk; Ben
> Heaven; berg...@googlemail.com
> ...
>
> read more »
Linda Gask
Linda
Ballini Luciana
All the best
luciana
-----Messaggio originale-----
Da: normalization...@googlegroups.com [mailto:normalization...@googlegroups.com] Per conto di C R May
Inviato: lunedì 28 maggio 2007 17.14
A: normalization...@googlegroups.com
Oggetto: RE: NPM: process and qualities
scott....@sunderland.ac.uk
On 24 May, 14:27, "MacFarlane, Anne" <anne.macfarl...@nuigalway.ie>
wrote:
> ...I am signed up without any pain or hassle - an IT first for me!
>
> Anne
>
> Anne MacFarlane, Ph.D
>
> Lecturer in Primary Care
>
> Department of General Practice
>
> No. 1 Distillery Road
>
> National University of Ireland, Galway
>
> Tel: ++ 353 91 495194
>
> Fax: ++ 353 91 495558
>
> e-mail anne.macfarl...@nuigalway.ie