Format

Send to

Choose Destination
BMC Med Inform Decis Mak. 2017 Aug 18;17(1):124. doi: 10.1186/s12911-017-0517-2.

"Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'.

Author information

1
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA. Peter.Scalia@dartmouth.edu.
2
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA.

Abstract

BACKGROUND:

Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings.

METHOD:

Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota.

RESULTS:

'Coherent' motivations were guided by financial incentives at CapitalCare, and by a 'champion' physician at HealthPartners. Nurses worked 'collectively' at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy.

CONCLUSION:

Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization.

KEYWORDS:

Decision support techniques; Implementation; Normalization process theory; Option grid™ encounter decision aids; Patient centered care; Shared decision making

PMID:
28821256
PMCID:
PMC5562992
DOI:
10.1186/s12911-017-0517-2
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center