Table 2.
Normalisation process theory coding frame for the management of chronic kidney disease in primary care11,12,15
| Coherence (Sense-making work)a | Cognitive participation (Relationship work)b | Collective action (Enacting work)c | Reflexive monitoring (Appraising work)d |
|---|---|---|---|
| Differentiation | Enrolment | Interactional workability | Reconfiguration |
| Defining, dividing up, and categorising task | Recruiting the self and others to tasks | Doing tasks, and making outcomes, in practice | Changing tasks |
| Are staff within an organisation clear on their roles regarding a particular task? | Do participants engage with other staff around a particular task? | How is a particular task/practice (e.g. disclosing CKD) enacted in consultations? | Has a particular task/practice been adapted based on experience? If so, how? |
| Are staff within an organisation clear on others' roles regarding a particular task? | Who initiates the engagement? | ||
| Who does and who does not ‘buy-in’ to a particular task? | How is a particular task brought into view? | ||
| How does a particular task fit with existing work? How have patients and professionals adapted to the introduction of a particular practice? | |||
| What effect does a particular task have on consultations? | |||
| How does the task/practice affect patient and professional contribution to dialogue? | |||
| Individual Specification | Initiation | Relational integration | Individual appraisal |
| Making sense of personal versions of tasks | Organising an individual contribution to tasks | Making and communicating reliable knowledge about tasks | Individual evaluation of contributions and tasks |
| Does a participant know what the task/practice is? | What organisational skills does a participant use to contribute to a particular task? (e.g. identifying CKD) | How does a particular practice/task (e.g. disclosing CKD) affect trust and confidence between parties (i.e. patients and professionals)? | Is it clear what effects a particular practice (e.g. identifying CKD) has had? |
| Is the task easy to describe? | Do individuals make efforts to reflect on/appraise a particular task? If so, how? | ||
| What benefits does a task/practice bring and to whom | Who actively engages with a particular task? | Howdoes a particular practice affect the patient–professional relationship? | Has appraisal work informed whether a particular task is advantageous for patients and staff? |
| Are individuals prepared to invest time energy and work into a particular practice? If so, what is this work? | How do individuals/parties work to enact a particular practice and maintain a relationship? | ||
| Communal specification | Activation | Skill set workability | Communal appraisal |
| Making sense of shared versions of tasks | Organising a shared contribution to tasks | Allocating tasks and performances | Shared evaluation of contributions and tasks |
| Do members of staff have a shared sense of purpose around a task? (GPs, nurses, reception staff, PM)? | Does the practice team undertake work to arrange a shared contribution to a particular task? | How is a particular task distributed within the practice team? | How does a practice team know that a particular practice has been carried out? |
| Who thinks a particular task/practice is a good idea? Who does not? | If so, what is this work? | What impact does the introduction of a practice/set of practices have on the distribution/division of labour, resources, power and responsibility? | Do participants contribute/share feedback about a particular practice (e.g. identifying CKD) with others? If so, what is discussed? |
| How does a particular task/practice (e.g. identifying CKD) feature in practice meetings? | |||
| Are the benefits of a particular practice/task (e.g. identifying CKD valued by all participants? | Is the work being devolved to others? | Has appraisal work informed whether a particular task is advantageous for patients and staff? | |
| If so, how and for what reason? | |||
| Does a particular task fit with the overall goals and activity of an organisation? | Is there alignment in approach towards a particular practice throughout the practice team? | ||
| Does the introduction of a particular practice/task alter the awareness of the work done by other members within a practice team? | |||
| Internalisation | Legitimation | Contextual integration | Systematisation |
| Learning how to do tasks in context | Making tasks the right thing to do | Supporting and resourcing tasks in their social context | Organising a reliable stock of knowledge about tasks |
| Is there an understanding of how to learn to do a task? | Is there work undertaken to ensure that a particular task is viewed as the right thing to do? If so, what is this work? | How is a particular task (e.g. identifying CKD) resourced? | Has the organisation developed ways of keeping up to date with a approaches to managing a set of practices (e.g. the management of CKD)? |
| Do staff have the time to learn to understand and carry out a particular task? | Do staff have the permission to carry out a particular task? | Is a particular task compatible with existing work practices? | |
| How is a particular task/practice (e.g. disclosing CKD) linked to, and resourced through, organisational structures (e.g. clinical information systems, decision support tools, practice meetings)? | |||
| How does the introduction of a particular practice (for example, managing CKD affect the relationship with existing structures? | |||