The clinician crowdsourcing challenge: using participatory design to seed implementation strategies

Abstract

Background In healthcare settings, system and organization leaders often control the selection and design of implementation strategies even though frontline workers may have the most intimate understanding of the care delivery process, and factors that optimize and constrain evidence-based practice implementation within the local system. Innovation tournaments, a structured participatory design strategy to crowdsource ideas, are a promising approach to participatory design that may increase the effectiveness of implementation strategies by involving end users (i.e., clinicians). We utilized a system-wide innovation tournament to garner ideas from clinicians about how to enhance the use of evidence-based practices (EBPs) within a large public behavioral health system. Methods Our innovation tournament occurred in three phases. First, we invited over 500 clinicians to share, through a web-based platform, their ideas regarding how their organizations could best support use of EBPs. Clinicians could rate and comment on ideas submitted by others. Second, submissions were judged by an expert panel (including behavioral scientists, system leaders, and payers) based on their rated enthusiasm for the idea. Third, we held a community-facing event during which the six clinicians who submitted winning ideas presented their strategies to 85 attendees representing a cross-section of clinicians and system and organizational leaders. Results We had a high rate of participation (12.3%), more than double the average rate of previous tournaments conducted in other settings (5%). A total of 65 ideas were submitted by 55 participants representing 38 organizations. The most common categories of ideas pertained to training (42%), financing and compensation (26%), clinician support and preparation tools (22%), and EBP-focused supervision (17%). The expert panel and clinicians differed on their ratings of the ideas, highlighting value of seeking input from multiple stakeholder groups when developing implementation strategies. Conclusions Innovation tournaments are a useful and feasible methodology for engaging end users, system leaders, and behavioral scientists through a structured approach to developing implementation strategies. The process and resultant strategies engendered significant enthusiasm and engagement from participants at all levels of a healthcare system. Research is needed to compare the effectiveness of strategies developed through innovation tournaments to strategies developed through design approaches.

Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

“…The BWS choice experiment was designed to quantify stakeholders' preferences for 14 implementation strategies developed through iterative elicitation, pilot, and pre-testing work completed with members of each stakeholder group in the target population [17,26]. Elicitation of strategies was completed via a system-wide innovation tournament, described elsewhere [27], through which clinicians submitted ideas for strategies to support EBP implementation in Philadelphia. Following the tournament, submitted ideas (N = 65) were analyzed and refined by a team of implementation scientists, behavioral scientists, and clinicians, in order to develop a set of distinct, clearly operationalized implementation strategies with ecological validity for the target system.…”

Positive organisational scholarship in healthcare

“…Specifically, there is now a need for research to clarify when, how and why ‘awareness and control of emotions [can] provide… the initial building blocks for building PsyCap’ (Brunetto et al, 2019), particularly via longitudinal research. Given the challenge of sustaining participant involvement over long periods – especially healthcare personnel – participatory methodologies and research methods might be helpful (Palmer et al, 2019; Stewart et al, 2019). There is also a need for research to clarify how to ‘embed concepts from positive psychology… into day-to-day practices… And… the ‘how’ of implementing a happiness-focussed initiative in aged care’ (Miller et al, 2019).…”

Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: A best-worst scaling choice experiment

“…The BWS choice experiment was designed to quantify stakeholders' preferences for 14 implementation strategies developed through iterative elicitation, pilot, and pre-testing work completed with members of each stakeholder group in the target population (17,26). Elicitation of strategies was completed via a system-wide innovation tournament, described elsewhere (27), through which clinicians submitted ideas for strategies to support EBP implementation in Philadelphia. Following the tournament, submitted ideas (N = 65) were analyzed and re ned by a team of implementation scientists, behavioral scientists, and clinicians, in order to develop a set of distinct, clearly operationalized implementation strategies with ecological validity for the target system.…”

“…This process resulted in a set of 14 implementation strategies (see Table 1: List of Implementation Strategies Included in the BWS Experiment), which were subsequently evaluated in pre-testing interviews with clinicians, supervisors, and administrators (n = 9) within the system to ensure that the strategies, as described, spanned the full range of approaches viewed as relevant by stakeholders and were clearly described. The 14 strategies fell into six categories: (1) nancial incentives, (2) clinical consultation, (3) clinical support tools, (4) clinician social support and networking, (5) clinician performance feedback/social comparison, and (6) client supports (27). Notably, the strategies developed through this process addressed 8 out of 9 categories of implementation strategies identi ed in the Expert Recommendations for Implementing Change (ERIC) project (18), including: use evaluative and iterative strategies, provide interactive assistance, develop stakeholder interrelationships, train and educate stakeholders, support clinicians, engage consumers, utilize nancial incentives, and change infrastructure.…”