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

Table 3 Exogenous factors that promote or inhibit the implementation of DSTs

User groups	Physicians	Patients	Managers
Skill-set workability	▪ Delegating to autonomous patients	▪ Skills for participation	▪ Specification of roles and competencies
	▪ Communicating clinical decisions and risks	▪ Accepting delegated clinical decisions	▪ Definition of standard operating procedures and job descriptions.
	▪ Identifying appropriate professional roles for DST delivery	▪ Gaining competence	▪ Defining decisions to meet organizational goals
	▪ Delegating to other professionals
	▪ Identifying and evaluating competencies
	▪ Defining boundaries between determinate and indeterminate decision-making
Contextual Integration	▪ Allocating physical media		▪ Managing allocation decisions
	▪ Allocating time		▪ Organizing protocols
	▪ Appraising value		▪ Controlling budgets
	▪ Negotiating with managers		▪ Managing professional autonomy
	▪ Managing medico-legal concerns.		▪ Managing patient choice

ISSN: 1748-5908