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BACKGROUND: Theories are important tools in the social and natural sciences. The methods by which they are derived are rarely described and discussed. Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes. This paper describes the process by which it was built. METHODS: Between 1998 and 2008, we developed a theory. We derived a set of empirical generalizations from analysis of data collected in qualitative studies of healthcare work and organization. We developed an applied theoretical model through analysis of empirical generalizations. Finally, we built a formal theory through a process of extension and implication analysis of the applied theoretical model. RESULTS: Each phase of theory development showed that the constructs of the theory did not conflict with each other, had explanatory power, and possessed sufficient robustness for formal testing. As the theory developed, its scope expanded from a set of observed regularities in data with procedural explanations, to an applied theoretical model, to a formal middle-range theory. CONCLUSION: Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development. The theory has been shown to merit formal testing.

The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.

Prologue: Medicare's prospective payment system (PPS) created incentives for the early discharge of hospitalized patients to subacute care: skilled nursing and intermediate care facilities, home health agencies, and long-term care hospitals. This study by Michael Morrisey, Frank Sloan, and Joseph Valvona examines changes in the proportion of patients transferred, the length-of-stay prior to transfer, and mean case-mix complexity of transferred patients. Their conclusions raise a number of issues for health policy and health care management Morrisey holds a doctorate in economics from the University of Washington. He was recently promoted to a full professorship in the Department of Health Care Organization at the University of Alabama's School of Public Health. Before joining the Alabama faculty in Birmingham three years ago, Morrisey worked for six years as a senior economist at the American Hospital Association's Hospital Research and Educational Trust (HRET). Other recent research pursuits include a study of employers' behavior in relation to their oft-discussed concern over rising medical care costs (The Milbank Quarterly, Winter 1987), which examined health insurance benefits based on data collected by the Bureau of Labor Statistics. Sloan is the Centennial Professor of Economics and chairman of the Department of Economics at Vanderbilt University. Sloan, who holds a doctorate in economics from Harvard University, also directs Vanderbilt's Health Policy Center. Valvona holds a position in corporate planning at the Vanderbilt Medical Center. He received a bachelor of science degree in biology from Emory University, a master of science degree in genetics from the University of Arizona, and a master of business administration degree in finance from Vanderbilt.

Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al. 's (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective.

Two of the most dangerous fault systems on the U。 West Coast may be more connected than scientists once thought。 New research suggests the Cascadia subduction zone and the San Andreas fault can “sync up,” triggering earthquakes within minutes or hours of each other

In 1987, The Milbank Quarterly published two special supplements on the health status of blacks in the United States. Dr. Vicente Navarro wrote a letter concerning the issues raised in these publications to the editor of The Milbank Quarterly, but the decision was made not to print it. Because of the importance of the subject involved, the letter is published here, with the hope of opening a debate on the issues discussed in The Milbank Quarterly's supplements and in Navarro's letter. Professor Miller, a major contributor to the supplements, will reply to Navarro's comments in an upcoming issue of this journal.

Fueled by public incidents and growing evidence of deficiencies in care, concern over the quality and outcomes of care has increased in both the United Kingdom and the United States. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leadership, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and decentralization in efforts to sustain the impetus for quality improvement over time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey.

A spectacular cosmic event nicknamed “SN Winny” could help solve one of astronomy’s biggest mysteries: how fast the universe is expanding。 This rare superluminous supernova, located 10 billion light-years away, appears five times in the sky thanks to gravitational lensing, creating a dazzling “cosmic fireworks” effect。 By measuring the slight delay

The FCC banned the sale of new consumer-grade Wi-Fi routers and mobile hot spots manufactured outside the US。 Here’s what it means for you

For decades, psychologists have debated whether the human mind can be explained by one unified theory or must be broken into separate parts like memory and attention。 A recent AI model called Centaur seemed to offer a breakthrough, claiming it could mimic human thinking across 160 different cognitive tasks。 But new research is challenging that bold

A decades-old cosmic mystery has finally been cracked: the strange X-rays coming from the bright star gamma-Cas are caused by a hidden stellar companion feeding off it。 Using cutting-edge observations from the XRISM space mission, astronomers discovered that an unseen white dwarf star is siphoning material from gamma-Cas, heating it to extreme temp

Hello HN,I was away from my computer for two weeks, and after coming back and reading the latest discussions on HN about coding assistants (models, harnesses), I felt very out of the loop。 My normal process would have been to keep reading and figure out the latest and greatest from people's comments, but I wanted to try and automate this process。Ba

Quantum physics once shocked scientists by revealing that particles can behave like waves—and now, that strange behavior has been pushed even further。 For the first time, researchers have observed wave-like interference in positronium, an exotic “atom” made of an electron and its antimatter partner, a positron。 This breakthrough not only strengthen

Scientists have discovered a way to help the brain clean itself of harmful Alzheimer’s plaques by activating its own support cells。 By increasing a protein called Sox9, researchers were able to boost the activity of astrocytes, star shaped cells that help maintain brain health。 In mice that already showed memory problems, this approach reduced plaq

People in Costa Rica and other Latin American, Asian and African countries are increasingly buying electric vehicles to avoid spiking fuel prices

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