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Background The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. Methods This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). Results In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. Conclusion NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients’ perceptions to evaluate outcomes.

This report is the product of research activity within the EC Seventh Framework Programme “Monitoring Developments for Safe Repository Operation and Staged Closure” (MoDeRn) Project. This project aims to further develop understanding of the role of monitoring in staged implementation of geological disposal to a level of description that is closer to the actual implementation of monitoring. It focuses on monitoring conducted to confirm the basis of the long term safety case and on monitoring conducted to inform on options available to manage the stepwise disposal process from construction to closure (including e.g. the option of waste retrieval). This report investigates the potential of citizen stakeholder engagement in the identification of monitoring objectives and the development of monitoring strategies for geological disposal of high level waste (HLW) or spent nuclear fuel (SNF). It builds on an earlier MoDeRn report describing monitoring the safe disposal of radioactive waste as a socio-technical activity (Bergmans, Elam, Simmons and Sundqvist 2012).

International audience

Monitoring is now widely seen as a necessary part of programmes for the geological disposal of radioactive waste. However, we find different perspectives on the nature and role of monitoring. Among technical experts it is viewed firstly as a matter of performance confirmation, a tool for validating the safety case underlying repository construction. Among concerned citizens we find a view of monitoring as enabling the critical scrutiny of safety, an instrument for acknowledging uncertainties and detecting emergent problems in a repository. After outlining differing views on questions of whether, why, what, where and for how long to monitor we discuss monitoring in light of constant vigilance as a technical and moral principle of nuclear safety. We suggest that how much monitoring and how should it be organised are societal questions and as such need to be broadly discussed.

This report analyses mediation and mediators in Swedish nuclear waste management. Mediation is about establishing agreement and building common knowledge. It is argued that demonstrations and dialogue are the two prominent approaches to mediation in Swedish nuclear waste management. Mediation through demonstration is about showing, displaying, and pointing out a path to safe disposal for inspection. It implies a strict division between demonstrator and audience. Mediation through dialogue on the other hand, is about collective acknowledgements of uncertainty and suspensions of judgement creating room for broader discussion. In Sweden, it is the Swedish Nuclear Fuel and Waste Management Co. (SKB) that is tasked with finding a method and a site for the final disposal of the nation’s nuclear waste. Two different legislative frameworks cover this process. In accordance with the Act on Nuclear Activities, SKB is required to demonstrate the safety of its planned nuclear waste management system to the government, while in respect of the Swedish Environmental Code, they are obliged to organize consultations with the public. How SKB combines these requirements is the main question under investigation in this report in relation to materials deriving from three empirical settings: 1) SKB’s safety analyses, 2) SKB’s public consultation activities and 3) the ‘dialogue projects’, initiated by other actors than SKB broadening the public arena for discussion. In conclusion, an attempt is made to characterise the longterm interplay of demonstration and dialogue in Swedish nuclear waste management.