Table 6 Adaptations/enhancements to systems consultation strategy

Clinic recruitment

Reach out to clinic directors personally (not by email) and hold recruitment meetings in person (not by conference call).

Request presence of prescribers and clinic leadership at recruitment meeting.

Bring food to recruitment meeting.

Change team composition and responsibilities

Seek representation from all occupational groups and work teams affected by the intervention.

Encourage participation of influential prescriber(s).

Encourage change team to institute regular communication with clinic staff who are not part of the change team.

Facilitate understanding of roles and responsibilities for change team members individually and collectively.

Consulting roles and responsibilities

Split consulting roles and responsibilities between a clinical expert (physician consultant) and a facilitator.

Be sure that physician consultants and study facilitators are consistent in their communications to the clinic change team.

Train consultants to assess clinic needs and provide tailored assistance.

Clarify upfront the nature and extent of consultants’ services (e.g., not available for direct patient care).

Provide explicit instruction in the purpose and use of consulting tools.

Be flexible about tool use.

Facilitate access to an electronic health records expert.

Schedule meetings at lunchtime and provide meals.

Plan and communicate agendas for meetings

Support intra- and inter-clinic knowledge sharing.

Leverage opportunities created by organizational policy.

Recognize and make use of similarities between new opioid prescribing practices and chronic disease management protocols already in place.