Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

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This paper reports on the findings of two rounds of semi-structured interviews with health professionals taking part in the Health Foundation's MAGIC programme to put shared decision making into practice.  It sets out the work required to implement shared decision making and to inform future efforts.

The study found that shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in developing and delivering interventions ('cognitive participation'), and when those interventions fit with existing skill sets and organizational priorities ('collective action') resulting in demonstrable improvements to practice ('reflexive monitoring'). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; 'coherence' was often missing.

The study concluded that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation.

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