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Reflexive Monitoring
Reflexive Monitoring 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.
