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Table 5 Described strategies to address identified characteristics

From: Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them — a scoping review

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]
Have a clear definition of team members’ roles [50, 53]
 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]
Allow for flexible patient pathways and scheduling [7, 75]
  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]
  1. HCPs healthcare providers, EHR electronic health record, SDM shared decision-making, CME continuing medical examination, CEU continuing education units