Table 9 NPT—understanding the process of implementation within practices

Coherence

Making the practice coherent

Differentiation

Does the practice differ from other work?

Indications from observation/interviews that the intervention (by component or whole) is differentiated from other work (conversely, indications that it is indistinct from other work)

Communal specification

Does the practice make sense to the group?

Examples of sense-making in group settings (or individual reflections on group sense-making) around what the intervention entails in terms of actions and consequences

Individual specification

Does the practice make sense to the individual?

Examples of sense-making at the individual level around what the intervention entails in terms of actions and consequences; also, instances where different individuals make sense of the intervention in differing ways

Internalisation

Does the practice link to personal norms and values?

Any links made by individuals regarding their personal/professional norms and values and how they align (or not) to what the intervention entails in terms of actions and consequences; also, any inferable links observed in meeting discussions

Cognitive Participation

Enrolling people into the practice

Legitimisation

Do they work together to produce agreement?

Indications from observation/interviews that the team has discussed the intervention and its implementation in the practice, looking for who was involved in discussions and whether or not people see things in the same way

Enrolment

Do they find ways to work together to engage in practice?

Indications from observation/interviews that the team has considered in practical terms how to implement the intervention, and looking for what plans (if any) were developed and who these plans involved. Consider how concrete and detailed these plans were and whether the individuals identified to act were involved in the assignment of tasks

Initiation

Do they initiate the practice in specific times and places, with resources?

Indications from observation/interviews as to whether people have acted as a result of intervention (whole or components), and when and how they have acted. Consider who the actors were, and what resources were required to act. Also consider plans to act which failed (and why they may have failed)

Activation

Do they collectively work out ways to sustain the practice over time?

Indications from observation/interviews that people within the practice have considered the maintenance of any actions as a result of the intervention or are sustaining work over time in any way; also, consider where they have the intent to sustain but fail to do so

Collective Action

Enacting the practice within context

Contextual integration

Do they work to realise necessary resources and direct them in support of the practice?

Consider how the practice or individuals involved allocate resources and whether this changes as a result of the intervention; consider how their decisions around resources might impact on uptake of the intervention (whole or components)

Relational integration

Do they do knowledge work to build accountability and maintain confidence in the practice and each other?

Consider how the practice or individuals within the practice make sense of the intervention in relation to each person’s responsibilities and capabilities to complete the actions implied and how the team works (or doesn’t) in order to achieve shared goals. Attend to points of weakness, where people lack confidence in the intervention or each other

Interactional workability

Do they develop ways to work with each other and other resources to accomplish the practice?

Following on from enrolment in the work, are there indications that the practice and individuals within the practice are building on their initial plans of work, making amendments where necessary or adjusting practices/resource allocations in order to achieve shared goals relating to the intervention.

Skill-set workability

Have they divided the labour out and know who will do what and how to accomplish the practice?

Consider from observation/interviews, how the practice has divided labour and how well defined their plans are as to who does what. Consider how this is communicated, and who is involved in decisions, and how well it suits understandings (individually and collectively) of people’s skills and capabilities

Reflexive monitoring

Monitoring and sustaining the practice over time

Systematisation

Do they work out a system to define, collect and collate information about effects?

Consider what the practice or individuals therein may decide to do to track progress—does it involve intervention components, or practice-developed strategies, or both? Consider failures to do this as well and where the failures may occur

Communal appraisal

Do they work together to evaluate the worth of the practice?

Consider any evidence of communal appraisal of the intervention and actions implied by the intervention—what is the group narrative around the value of the intervention?

Individual appraisal

Do they appraise the practice from their own experience?

Consider any evidence of individual appraisal of the intervention and actions implied by the intervention—what individual narratives are identifiable around the value of the intervention, and do they match any communal narratives?

Reconfiguration

Do they do any work to redefine or modify practice?

Consider whether the practice or individuals therein have amended or redefined the actions undertaken as a result of the intervention over time, and any rationales for changes