Table 1 Agents and for mechanisms for Normalisation Process Theory

Agents

Agents are individuals and/or groups who contribute to the processes that lead to implementation, embedding, and integration of new practice. For this study, agents are healthcare professionals (admitting Medical Officer, Registered Nurse, Social Workers and RN ACP facilitators). They use the NSW Health ‘ACP – Making your wishes known’ information to patients, to initiate, engage in discussion, and answer any questions.

Coherence

This involves what and how things should be done which starts with how it has been done and what we should do differently. The meaning of new practice needs to be learned, experienced and internalised by the agents. The agents in this study are provided with the opportunities to learn, experience and internalise.

Cognitive participation

When the process of coherence is internalised, the agents engage in a new practice across the context. The agents in this study are given 6 months to internalise and normalise ACP as a routine practice.

Collective action

The new practice is operated and enacted in practice. In this study, material and human resources, working relationships between agents, a degree of autonomy are closely monitored and enacted upon.

Reflexive monitoring

This is an evaluation of implementation process. The agents will engage in an evaluation of the implementation process that reflects cognitive participation and collective action. It involves both individual and group appraisal and reconfiguration of ACP practice to embed and sustain a new ACP practice.