Normalization Process Theory and minimally disruptive medicine

by Victor Montori

I have just spent a glorious week with colleagues in the UK who are all pioneers in formulating a sociological theory of work called Normalization Process Theory.  We were brought together by the very generous Carl May, the convener of this group and key intellect along with Tracy Finch, Tim Rapley, and several others behind NPT — all “eminent, esteemed, and lovely”.

I was given the opportunity to share some notes about fitting healthcare to the patient using shared decision making and minimally disruptive medicine and how we were using NPT to support this work.  My presentation is here:

During these proceedings, the official website (which is curated by the developers as opposed to the otherwise accurate wikipedia page version) for NPT was launched, including the very useful NPT Toolkit, currently in beta.

The NPT toolkit boils down the theory into 16 questions.  The point of working thru these questions is not to reach an answer, but to think through — while addressing these questions — the process by which an intervention, a study, a treatment will become implemented, enacted, embedded, i.e., normalized, into existing routines.  The questions are challenging and invite thoughtful discussion.  I want to start using these with patients to uncover the work of adhering to complex medical regimens.

The developers are anxiously waiting for users to provide feedback and promise to be responsive.  Since this is the theory underpinning minimally disruptive medicine, my enthusiasm for a toolkit that will make it more accessible to practical people is very high.

The other attractive feature of the toolkit is the resulting report.  While this gives a sense of “destination” — when I say above that the “journey” is where the value lies, the plots suggest the notion of footprint that I have found so critical to understand healthcare in the lives of patients.

Go explore the site and post comments there and here.

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