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. 2018 Mar 9;13(1):40.
doi: 10.1186/s13012-018-0731-z.

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

Isabelle Scholl  1   2 , Allison LaRussa  3 , Pola Hahlweg  4 , Sarah Kobrin  5 , Glyn Elwyn  3
Affiliations

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

Isabelle Scholl et al. Implement Sci. .

Abstract

Background: Shared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. No reviews have solely focused on an in-depth synthesis of the literature around organizational- and system-level characteristics (i.e., characteristics of healthcare organizations and of healthcare systems) that may affect SDM implementation. A synthesis would allow exploration of interventions to address these characteristics. The study aim was to compile a comprehensive overview of organizational- and system-level characteristics that are likely to influence the implementation of SDM, and to describe strategies to address those characteristics described in the literature.

Methods: We conducted a scoping review using the Arksey and O'Malley framework. The search strategy included an electronic search and a secondary search including gray literature. We included publications reporting on projects that promoted implementation of SDM or other decision support interventions in routine healthcare. We screened titles and abstracts, and assessed full texts for eligibility. We used qualitative thematic analysis to identify organizational- and system-level characteristics.

Results: After screening 7745 records and assessing 354 full texts for eligibility, 48 publications on 32 distinct implementation projects were included. Most projects (N = 22) were conducted in the USA. Several organizational-level characteristics were described as influencing the implementation of SDM, including organizational leadership, culture, resources, and priorities, as well as teams and workflows. Described system-level characteristics included policies, clinical guidelines, incentives, culture, education, and licensing. We identified potential strategies to influence the described characteristics, e.g., examples how to facilitate distribution of decision aids in a healthcare institution.

Conclusions: Although infrequently studied, organizational- and system-level characteristics appear to play a role in the failure to implement SDM in routine care. A wide range of characteristics described as supporting and inhibiting implementation were identified. Future studies should assess the impact of these characteristics on SDM implementation more thoroughly, quantify likely interactions, and assess how characteristics might operate across types of systems and areas of healthcare. Organizations that wish to support the adoption of SDM should carefully consider the role of organizational- and system-level characteristics. Implementation and organizational theory could provide useful guidance for how to address facilitators and barriers to change.

Keywords: Decision aids; Health policy; Health system -level characteristics; Implementation; Implementation science; Incentives; Leadership; Organizational -level characteristics; Routine care; Shared decision-making.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

IS conducted one physician training in shared decision-making for which she received travel compensation from Mundipharma GmBH in 2015. AL and PH have no competing interests to declare. SK has no competing interests to declare and is an employee of the US government. GE reports personal fees from EMMI Solutions LLC, National Quality Forum, Washington State Health Department, PatientWisdom LLC, SciMentum LLC, Access Community Health Network, and Radcliffe Press outside the submitted work. GE has initiated and led the Option Grid TM patient decisions aids collaborative, which produces and publishes patient knowledge tools.

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Figures

Fig. 1
Fig. 1
Flow chart of study selection. *Reasons for exclusion: I1: 2 in total (1 full text from primary search, 1 full text from secondary search). I2: none. I3: 33 in total (29 full texts from primary search, 4 full texts from secondary search). I4: 157 in total (113 full texts from primary search, 44 full texts from secondary search). I5: 10 in total (8 full texts from primary search, 2 full texts from secondary search). E1: 61 in total (58 full texts from primary search, 3 full texts from secondary search). E2: 22 in total (17 full texts from primary search, 5 full texts from secondary search). E3: 21 in total (20 full texts from primary search, 1 full texts from secondary search)
Fig. 2
Fig. 2
Overview of identified characteristics. Main categories are displayed in bold; subcategories are listed as bullet points. The dashed line around the organizational characteristics indicates that these characteristics are influenced by health system characteristics
See this image and copyright information in PMC

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