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Table 1 Normalization Process Model from May et al. 2007

From: What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model

The collective action and interactions of patients, professionals and others are governed by four factors. We have derived questions from these factors as follows:

(i) Interactional workability: This refers to how work is enacted by the people doing it. A complex intervention will affect co-operative interaction over work (congruence), and the normal pattern of outcomes of this work (disposal).

How does collaborative care for depression (CCD) impact on basic communication, clinical care and treatment at the level of patient and professional?

(ii) Relational integration: This refers to how work is understood within the networks of people around it. A complex intervention will affect not only the knowledge required by its users (accountability), but also the ways that they understand the actions of people around them (confidence).

How does CCD impact on the way that health professionals relate to each other?

Does it seem to be the right thing to be doing?

It is perceived as valid and/or useful?

Who needs to be involved in the work?

How do we inform them and link with them?

(iii) Skill-set workability: This refers to the place of work in a division of labor. A complex intervention will affect the ways that work is defined and distributed (allocation), and the ways in which it is undertaken and evaluated (performance).

Does this mean health professionals learning new skills or doing things differently?

Is there a person available with the right set of skills to implement CCD?

Does CCD challenge professional autonomy over working practices?

Does it impact on case load and allocation of work?

(iv) Contextual integration: This refers to the organizational sponsorship and control of work. A complex intervention will affect the mechanisms that link work to existing structures and procedures (execution), and for allocating and organizing resources for them (realization)

Who has the power to make CCD happen?

Does the system want it to happen?

How can we divert resources to it?