NoMAD: is a new way of working taking hold?

In short

A 23-question staff survey that shows whether a new practice is becoming part of normal work. Use it during and after an AI rollout, not before.

For whoever runs the assessment: an HR or operations lead, an internal project team, or an outside consultant.

What it measures

NoMAD asks the people who have to use a new practice four things:

• Does it make sense to them?
• Are they and their colleagues committed to it?
• Is the work of doing it organized and supported?
• Do they look at how it is going and adjust?

Together the answers show whether the new practice is becoming routine or staying a side project.

How to use it

1. Name the practice clearly: for example, “drafting customer replies with the AI assistant”.
2. Ask the staff who use it, a few weeks after the start.
3. Look at which of the four areas is weakest. Each points to a different fix: explanation, commitment, support or review.
4. Ask again after three to six months and compare.

It fits the pilot stage well. See start with one costly process.

What it does not measure

• Readiness before a rollout. It only makes sense once people have started using the new practice.
• AI specifically. It was built in healthcare for any new way of working. You name the practice yourself.
• Results. It shows whether the practice is taking hold, not whether it pays off.

How it was tested

• The questions were developed with 30 interviews in which staff talked through how they understood each one.
• The final 23 questions were tested on 831 staff at six sites. The answers grouped into the four areas as the theory predicts.
• A Swedish version was tested on 144 people and a Dutch version on 262. Both worked acceptably. In the Dutch version one question performed weakly and the final form has 20 questions.

The technical detail: a statistical test of the four-part structure fitted well, and the overall scale was consistent (alpha 0.89).

Licence and access

The articles are open access under a CC BY licence, and the questions are printed in them. The Swedish and Dutch studies show the pattern to follow for any other language: translate, check with staff, then test again.

Alternatives

Other assessments with a similar job, and when to prefer each.

• Are staff committed to this change, and do they believe it can be done? Organizational Readiness for Implementing Change (ORIC) Prefer it before the rollout, to ask whether staff are ready for the change. Staff, about their organization or team · 12 questions Not established Testing: Moderate Readiness surveys
• What will help or block the rollout? Consolidated Framework for Implementation Research (CFIR) Prefer it when you want to find out why a rollout is stuck, through interviews. People at several levels, in interviews · Interviews on the factors you choose, out of 48 Free to use, ask before changing Testing: Strong Interview guides and checklists

The details

Testing

Strong Tested on 831 staff at six sites, and the results held up. Separate teams then tested Swedish and Dutch versions, with acceptable results.

Looks at

Person, Team

How the answers are collected

A survey answered by the staff who are expected to use the new practice.

Length

23 questions

Cost

Free

Licence

CC BYYou may translate and adapt the questions if you credit the authors. The questions are printed in the article.

Languages

English, Swedish, Dutch (the Dutch version has 20 questions)

By

Finch, Rapley and colleagues, 2018

Sources

1. Finch, Girling, May, Mair, Murray and colleagues (2018). Improving the normalization of complex interventions: part 2 – validation of the NoMAD instrument. BMC Medical Research Methodology. doi:10.1186/s12874-018-0591-x
2. Rapley, Girling, Mair, Murray, Treweek and colleagues (2018). Improving the normalization of complex interventions: part 1 – development of the NoMAD instrument. BMC Medical Research Methodology. doi:10.1186/s12874-018-0590-y
3. Elf, Nordmark, Lyhagen, Lindberg, Finch and colleagues (2018). The Swedish version of the Normalization Process Theory Measure S-NoMAD. Implementation Science. doi:10.1186/s13012-018-0835-5
4. Vis, Ruwaard, Finch, Rapley, de Beurs and colleagues (2019). Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals. Journal of Medical Internet Research. doi:10.2196/12376

Related studies on this site

• Does readiness for change predict success? A review of 47 studies Caci, Nyantakyi, Blum, Sonpar, Schultes, Albers and Clack (2025). Organizational readiness for change: A systematic review of the healthcare literature. Implementation Research and Practice, 6.