Table 1 The four key elements of Normalisation Process Theory (from May 2009 [33] and www.normalizationprocess.org)

Coherence: a set of ideas about the meaning, uses and utility of a practice, (defined as an ensemble of beliefs, behaviours, and acts that manipulate or organize objects and others), which hold the practice together and make it possible to share and enact it.

This is the sense-making work that people do individually and collectively when they are faced with the problem of operationalizing some set of practices

Cognitive participation: the symbolic and real enrolments and engagements of human actors that position them for the interactional and material work of collective action.

This is the relational work that people do to build and sustain a community of practice around a new technology or complex intervention

Collective action: the chains of interactions which are the site of mental and material work to organise and enact practice which might include reshaping behaviours or actions, employing objects or artefacts, or reorganising relationships and contexts.This is the operational work that people do to enact a set of practices, whether these represent a new technology or complex healthcare intervention

Reflexive monitoring: the continuous evaluation, both formally and informally, of implementation processes by participants, which may involve judgments about the utility and effectiveness of a new practice with reference to socially patterned and institutionally shared beliefs

This is the appraisal work that people do to assess and understand the ways that a new set of practices affect them and others around them