Understanding the work of telehealth implementation using Normalization Process Theory

This dissertation uses the theoretical constructs of Normalization Process Theory (NPT) to examine the successful implementation of an innovative telehealth service that delivers occupational health nursing services to a large healthcare employee population over a wide geographic area. Telehealth services have come to be regarded as a possible means to improve access to health care services, clinical efficiency, and cost effectiveness in an era where there are shrinking resources and growing health care demands. Yet there is still much to be learned about how these complex interventions advance beyond pilot projects to become the normal way of working.Using a case study of a successful re-organization of occupational health nursing services, the study used qualitative data collection methods: semi-structured interviews, analysis of documents, and site observations. Data were analyzed using the framework method of analysis informed by the constructs of NPT. This study adds to a growing literature that supports the utility of NPT in identifying the work necessary to successfully implement complex interventions in healthcare settings. It underlines the importance of understanding technology as practice, and suggests prospective applications of the theory.