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. Like all NPT constructs, it has four
components
4.1 Systematization: participants in any set of
practices may seek to determine how effective and useful it is for
them and for others, and this involves the work of collecting
information in a variety of ways. The work of systematization
may be highly formal - the Randomized Controlled Clinical Trial is
a prime example of formal systematization. But it may also be very
informal, the collection of anecdotal examples of problems in
practice around a set of common themes by an unqualified care
assistant is every bit as much an example of the systematization of
information.
4.2 Communal appraisal: participants work
together - sometimes in formal collaboratives, sometimes in
informal groups to evaluate the worth of a set of practices. They
may use many different means to do this drawing on a variety of
experiential and systematized information. These events happen
continuously in almost every setting where people interact around a
piece of hardware or new way of organizing work and ask each other
'is it working?' How they put the answers to these questions and
negotiate the difficulties that stem from conflicts about what sort
of information counts, and how it counts for different groups, are
central to the future of any set of practices. Acts of communal
appraisal - like data analysis meetings in clinical trials, or
quality circles in lean healthcare organizations - are common and
may be highly formalized as well as casual and informal.
4.3 Individual appraisal: Participants in
a new set of practices also work experientially as individuals to
appraise its effects on them and the contexts in which they are
set. From this work stem actions through which individuals express
their personal relationships to new technologies or complex
interventions. For example, a nurse working in a falls
prevention program will work to appraise not only the worth of the
program, but also its impact on her other tasks. So, a falls
program that complicates and adds to an already complicated and
demanding workload may well be have a low value attributed to it in
practice irrespective of its effects on falls within the
hospital.
4.4 Reconfiguration: appraisal work by
individuals or groups may lead to attempts to redefine procedures
or modify practices - and even to change the shape of a new
technology itself. For example, a nurse leading a falls
prevention program might look again at the ways in which risk of
falling was calculated in practice and the demands that this risk
placed on the delivery of nursing care elsewhere on the ward. If
the work of calculating risk of falling was disproportionate to the
work involved in dealing with other kinds of risks on the ward,
then there would be pressure to modify the falls prevention program
to make it workable in practice.