Table 1 The Normalisation Process Model-a summary of the original model (adapted from May 2006)

1: Interactional workability

1.1 Congruence

Co-operation

The interactional work that professionals and patients do within the clinical encounter and its temporal order

(the process of interaction)

(shared expectations, minimise disruption)

Legitimacy

(shared beliefs about objects and roles)

Conduct

(verbal and non-verbal)

1.2 Disposal

goals

(the effects of interaction)

meaning

outcomes

Proposition 1: A complex intervention is disposed to normalization if it equals or improves accountability and confidence within networks.

2: Relational integration

2.1 Accountability

Validity

The embeddedness of trust in professional knowledge and practice

(internal credibility)

Expertise

Dispersal

2.2 Confidence

Credibility

(external credibility)

Utility

Authority

Proposition 2: A complex intervention is disposed to normalization if it equals or improves accountability and confidence within networks.

To summarize (constructs 1 & 2): The clinical encounter and the social relations that surround it are historically and culturally stable. Where a complex intervention interferes with the order of professional/patient interaction, either by disrupting the interaction between professionals and patients, or by undermining confidence in the knowledge and practice that underpins it, then it is also an unlikely candidate for normalization.

Exogenous processes comprise the ways that work is organized, its division of labour, and the institutional structures and organizational processes in which it is located

3: Skill set workability

3.1 Allocation

Distribution

The organizational distribution of work, knowledge and practice across divisions of labour

Definition

Surveillance

3.2 Performance

Resourcing

Power

Evaluation

Proposition 3: A complex intervention is disposed to normalization if it is calibrated to an agreed skill-set at a recognizable location in the division of labour.

4: Contextual Integration

4.1 Execution

Resourcing

The capacity of the health care organization to allocate control and infrastructure resources and to negotiate integration into existing activities

(the ownership of control over the resources and agents required to implement chiropractic)

Power

Evaluation

4.2 Realization

Risk

(the allocation and ownership of responsibility for implantation)

Action

Value

Proposition 4: A complex intervention is disposed to normalization if it confers an advantage on an organization in flexibly execution and realizing work.

To summarise (constructs 3 & 4): to be an optimal candidate for normalization, a complex intervention must “fit” with an actual or realizable set of roles within an organizational or professional division of labour, and at the same time must be capable of integration within existing or realizable patterns of service organization and delivery.