Table 5 Described strategies to address identified characteristics
Characteristics | Strategies described |
|---|---|
Organizational-level strategies | |
Organizational leadership | |
Corporate mission and vision statement | Develop and promote a strong consistent message about importance of SDM [72] Make the value of SDM clear to physicians [83] Revise policy and procedure documents to include SDM in those directives [104, 105] |
Encouragement | Appoint an internal champion/have clinical champions [7, 54, 58, 59, 68, 87, 100, 103, 108] Provide personal testimonials from leaders [51] Support healthcare professionals (HCPs) in learning SDM skills, e.g., by protecting time to get trained [7, 47, 51, 58] Support SDM implementation at all levels of the organization’s leadership [51, 59, 100, 102] Show interest by doing site visits to clinics/teams implementing SDM [7] Share success stories in grand rounds [58] |
Performance measurement and feedback | Provide continuous performance monitoring and feedback on SDM performance, decision aid distribution rate, decision quality, and patient satisfaction rates [7, 52, 53, 58, 69, 72, 81, 92, 104, 105, 108, 109] |
Organizational culture | Foster a well-organized and amicable work environment [50] Align SDM implementation with organization’s existing patient-centered philosophy and quality improvement spirit [51, 52] |
Autonomy of staff | Allow flexible use of decision aids and freedom on how to achieve SDM implementation goals [7, 47, 51] |
Shared views and goals | Address relational dynamics of healthcare teams before SDM implementation [89] Hold regular meeting to share goals and successes [54] |
Organizational teamwork | |
Communication | Foster frequent, timely, accurate, and problem solving communication about SDM implementation within and between teams [7, 89, 97] |
Coordination of care | Implement multidisciplinary teams [79, 102] Have a patient navigator [102] |
Organizational resources | |
Time | Decrease pressure for short patient interactions [105]/expand time to spend with patient [58, 103] Tailor interaction length guidelines for type of interaction [104] |
Financial resources | Obtain funding for SDM activities [90] Have access to high quality decision aids at low or no cost [52] |
Space | Use offices instead of clinical exam rooms for delivering decision support [74] |
Workforce | Engage non-physician personnel (e.g., nurses, office staff) [60, 70, 73, 90] Use unpaid or paid student interns or volunteers to deliver decision support [76, 77] Reorganize workforce responsibilities from over utilized to underutilized staff [74] Fund/hire a decision support/ care coordinator [77, 98] Salaried physicians for which SDM is part of employment obligations [51] |
Organizational priorities | Integrate SDM into other interventions or changes (e.g., health coaching, chronic disease management program) [7, 94, 110] Align SDM with wider objectives of the organization (e.g., quality and safety) [7, 58] |
Organizational workflows | |
Patient information dissemination strategies | Automate decision aid distribution, e.g., pre-visit [78], based on triggers [70], send by mail [58, 75, 90] Keep decision aids/tools accessible in exam rooms and workspaces [7, 86, 87] and make them easily available electronically [7, 58, 105] Offer in-office viewing of decision aids as well as other options (e.g., lending them to patients) [52] Align delivery of decision aids with other aspects of care (e.g., obtaining informed consent) [91] Partner with resource centers to deliver decision support [77] Clarify the place that decision aids have in the clinical pathway [103] Make decision aids available via a state-run website [51] Create protocols to prompted staff members to prescribe decision aid corresponding to the reason for referral [70] |
Scheduling routines and time frames | Get decision aids to patients prior to consultations [50, 52] Install scheduling system for SDM/decision aids/decision support [74, 103, 108] Require slowing down the flow of decision-making/reduce time pressure on patient path to treatment decision [58, 91] |
Electronic health record (EHR) | Use EHR to prompt and document SDM process [7, 54, 70, 73] Use EHR (and merge it with computerized scheduling data) to identify patients eligible for decision aids [69, 73, 78, 87, 90] Have decision aids available on EHR for easy access and have them available of patient portal on EHR [52, 58, 95, 104, 108] |
System-level strategies | |
Incentives | |
Payment model | Use a payment model that motivates providers to engage in SDM (e.g., patient-centered medical home) [51, 52, 92] Reimburse the use of a decision aid and time spent engaging in SDM conversation [91, 96, 103] Move away from fee-for-service to alternative model (e.g., pay-for-performance) [53,54,55] |
Accreditation/certification criteria | Revise accreditation/certification criteria by adding the implementation of SDM as criterion/quality indicator [51] |
Policies and guidelines | |
Legislation | Create state legislation that fosters SDM (e.g., comparable to Washington state: enhanced legal protection when doing SDM) [51, 56, 57] Create legislation that encourages healthcare organization structures that support SDM [51] |
Practice guidelines | Incorporate the use of SDM in clinical practice guidelines [103, 105] |
Quality indicators | Make the use of decision aids a quality of care indicator/list SDM as performance metric [55, 87, 91] Health plans could collect and distribute SDM performance data [51] Use a national set of measures [58] |
Culture of healthcare delivery | Promote culture of patient engagement in medical school [59] |
Education and licensing | Incorporate SDM communication skills (as compulsory) into medical school and residency curricula, as well as into state medical licensing criteria [51, 58,59,60] Offer CME/CEU credits for watching decision aids/for SDM training [54, 84, 109] |