A rational model for assessing and evaluating complex interventions in health care

Background: understanding how new clinical techniques, technologies and other complex interventions become normalized in practice is important to researchers, clinicians, health service managers and policy-makers. This paper presents a model of the normalization of complex interventions.Methods: between 1995 and 2005 multiple qualitative studies were undertaken. These examined: professional-patient relationships; changing patterns of care; the development, evaluation and implementation of telemedicine and related informatics systems; and the production and utilization of evidence for practice. Data from these studies were subjected to (i) formative re-analysis, leading to sets of analytic propositions; and to (ii) a summative analysis that aimed to build a robust conceptual model of the normalization of complex interventions in health care.Results: a normalization process model that enables analysis of the conditions necessary to support the introduction of complex interventions is presented. The model is defined by four constructs: interactional workability; relational integration; skill set workability and contextual integration. This model can be used to understand the normalization potential of new techniques and technologies in healthcare settingsConclusion: the normalization process model has face validity in (i) assessing the potential for complex interventions to become routinely embedded in everyday clinical work, and (ii) evaluating the factors that promote or inhibit their success and failure in practic

Public ownership in the pursuit of economic democracy in a post-neoliberal order

Nowhere are the failings of the neoliberal political and economic order more evident than in its signature project of privatisation. As privatisation and marketised solutions continue to fail, state intervention and public ownership are coming back, in diverse ways, to the management and governance of the economy. This chapter critically appraises the return of public ownership and its wider significance for a more progressive political economy. It is particularly concerned with the potential to create democratic forms of economy out of the crisis of neoliberal governance, whilst avoiding the failings of older hierarchical forms of state management in the twentieth century. The wider arguments are illustrated through the lens of the energy sector and the failures there of faux market solutions compared with the potential for public ownership and planned responses to deal with the climate emergency. Alternative examples of more democratic, less hierarchical forms of public ownership are illustrated