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Table 1 Definitions of constructs and dimensions of the Normalization Process Model applied to Decision Support Technologies

From: Arduous implementation: Does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice

NPM Constructs NPM Dimensions
Interactional Workability: People operationalize a DST when they engage in work that characterized by specific patterns of conduct (congruence), and expectations about their outcomes (disposal). Congruence requires shared expectations of the normal conduct and purpose of the clinical encounter; the roles of participants; and the legitimacy of shared decision-making. Disposal of participants' problems requires agreement about the meaning and consequences of the shared decision; and expectations of the goals and possible outcomes of the clinical encounter
Relational Integration People organize a DST through working to share knowledge and practice (accountability), and beliefs about its value and meaning (confidence). Accountability requires agreement about the knowledge and expertise that underpins the shared decision; beliefs about their validity and significance; and agreement about the interpretive contribution of participants. Confidence requires agreement about the authority and credibility of the knowledge and expertise through which the shared decision is framed; or beliefs about the utility of this knowledge and the criteria by which it is evaluated.
Skill-set workability People distribute the work connected to mobilizing a DTS according to specific formal or informal roles (allocation), and evaluated by reference to shared beliefs about action (performance). Allocation requires agreement about the assignment of shared decision-making tasks to participants; beliefs about the ownership and appraisal of the skills; the distribution of resources and rewards; and mechanisms to record participation. Performance requires agreement about the content of shared decision-making tasks assigned to participants; shared beliefs about the boundaries of their responsibility; and mechanisms to decide the degree of autonomy available to them.
Contextual Integration People enact a DST by working to assign the necessary intellectual property, personnel, and material resources (execution); and to seek to link it to its operational contexts by sustaining the allocation of these resources (realization). Execution is made possible by participants' agreement about distributing responsibility for the conduct of shared decision-making; policies for allocating intellectual and capital resources to participants; and mechanisms for linking participation to organizational structures. Realization is made possible by participants' agreement about the value of shared decision-making; policies about the procurement and delivery of personnel and equipment; and mechanisms for modifying organizational objectives.