Table 1.

Normalization process theory constructs with a focus on collective action components

NPT Construct	Description	Questions for our Study
Coherence	Sense-making work	Do practice members individually and collectively agree about the purpose of care management, their role in it, and the value of it?
Cognitive Participation	Relational work	Do practice members buy into care management, drive it forward, and support it?
Reflexive Monitoring	Appraisal work	Do practice members have a means of assessing the value of care management and are able to modify their work in response?
Collective Action	Enacting work	Do practice members perform the tasks required to implement care management, trust each other’s work and expertise with it and have adequate support for it?
Collective Action Components:
Contextual Integration	Refers to the fit between the new intervention and the overall organizational context; includes organizational goals, morale, leadership and resources.	Does the physician organization support care management in all important ways? Does the practice support care management? Are they capable of implementing it?
Skill Set Workability	Refers to the fit between the new intervention and existing skill sets; also includes allocation of work issues. If a complex intervention requires groups of professionals to work above or below their current skill set, it is unlikely to normalize.	Are practice members adequately allocated to roles supporting care management? Are practice members adequately trained to implement care management?
Interactional Workability	Refers to the impact a new intervention has on interactions, particularly the interactions between health professionals and patients.	To what extent do interactions (or lack of) support implementation of care management? To what extent do communication vehicles (such as electronic medical record messaging) support implementation of care management?
Relational Integration	Refers to the impact of the new intervention on relations between different groups of professionals; includes issues of power and trust.	How does the implementation of care management affect relationships between practice members?