Normalization process theory
A sociological account of how a new practice becomes embedded as routine, everyday work rather than a temporary project.
What it means
NPT explains implementation by focusing on the collective work people do to make a new practice normal, organized around four mechanisms: coherence (does it make sense to us?), cognitive participation (will key actors buy in and sustain it?), collective action (can we operationalize it in real workflows?), and reflexive monitoring (how do we appraise and adjust it?). Unlike individual behavior-change models, it treats embedding as social and emergent — the unit of analysis is the work, not the attitude. This makes it especially useful in complex settings like healthcare, where interventions that 'work' in trials still fail to stick. Its critique is that it diagnoses why implementation succeeds or fails better than it prescribes how to fix it. It matters because it shifts attention from 'do staff intend to comply?' to 'is this practice becoming part of how work is actually done?'.
Examples
A new sepsis-screening protocol normalizes only when clinicians grasp its purpose, agree to own it, fit it into ward routines, and keep refining it — not when a memo announces it.
A new project tracker becomes real only when teams see the point, someone owns it, it fits how work already flows, and they keep adjusting it — not when the licence is paid.
A school's new marking policy sticks when heads of department champion it, it fits into the marking week, and staff review it each term; otherwise it lives in a folder nobody opens.
First described in Carl May & Tracy Finch (2009).