Embedding new technologies in practice - a normalization process theory study of point of care testing.

Caroline H D Jones, Margaret Glogowska, Louise Locock, Daniel S Lasserson

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Many point of care diagnostic technologies are available which produce results within minutes, and offer the opportunity to deliver acute care out of hospital settings. Increasing access to diagnostics at the point of care could increase the volume and scope of acute ambulatory care. Yet these technologies are not routinely used in many settings. We aimed to explore how point of care testing is used in a setting where it has become 'normalized' (embedded in everyday practice), in order to inform future adoption and implementation in other settings. We used normalization process theory to guide our case study approach.We used a single case study design, choosing a community based ambulatory care unit where point of care testing is used routinely. A focused ethnographic approach was taken, including non-participant observation of all activities related to point of care testing, and semi-structured interviews, with all clinical staff involved in point of care testing at the unit. Data were analysed thematically, guided by normalization process theory.Fourteen days of observation and six interviews were completed. Staff had a shared understanding of the purpose, value and benefits of point of care testing, believing it to be integral to the running of the unit. They organised themselves as a team to ensure that point of care testing worked effectively; and one key individual led a change in practice to ensure more consistency and trust in procedures. Staff assessed point of care testing as worthwhile for the unit, their patients, and themselves in terms of job satisfaction and knowledge. Potential barriers to adoption of point of care testing were evident (including lack of trust in the accuracy of some results compared to laboratory testing; and lack of ease of use of some aspects of the equipment); but these did not prevent point of care testing from becoming embedded, because the importance and value attributed to it were so strong.This case study offers insights into successful adoption of new diagnostic technologies into every day practice. Such analyses may be critical to realising their potential to change processes of care.
Original languageEnglish
Article number591
Number of pages1
JournalBMC Health Services Research
Publication statusPublished - 19 Oct 2016

Bibliographical note

This research was funded by the NIHR Diagnostic Evidence Co-operative Oxford. CJ was funded by the National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Oxford. DL is funded by the NIHR Oxford Biomedical Research Centre (BRC) and NIHR Oxford Collaboration for Leadership in Applied Health Research and Care (CLAHRC). LL is funded by the NIHR Oxford BRC. MG is funded by the NIHR Oxford CLAHRC. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funding body had no role in the design of the study, the collection, analysis, and interpretation of data, or writing the manuscript.


  • ambulatory care
  • case study
  • diagnostic tests
  • ethnography
  • normalization process theory
  • point of care technology


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