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Cited by 331Health Policy Implementation SciencePatient-Provider Communication in HealthcarePalliative Care and End-of-Life Issues

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

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Scholl, Isabelle, LaRussa, Allison, Hahlweg, Pola, Kobrin, Sarah, Elwyn, Glyn·2018·Implementation Science
DOI 10.1186/s13012-018-0731-zPMC PMC5845212
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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.

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  • Organizational leadership is a critical determinant of the successful implementation of universal prevention programs in schools.

    “Organizational leadership is a critical determinant of the successful implementation of these programs.”

    From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [3]

    The Abstract Results identify organizational leadership as a factor influencing implementation of shared decision-making in healthcare. The source does not study universal prevention programs in schools, and its conclusions are more cautious than calling leadership a critical determinant of successful implementation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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References 90 · Cited by 331

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Authors
Scholl, I., LaRussa, A., Hahlweg, P., Kobrin, S., & Elwyn, G.
Affiliations
  • Dartmouth College (US)
  • University Medical Center Hamburg-Eppendorf (DE)
  • National Institutes of Health (US)
Corresponding author
Scholl, Isabelle
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2018-03-09
Volume
13
Issue
1
Pages
40-40
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/s13012-018-0731-z
PMC
PMC5845212
OpenAlex
W2789411591
Cited by
331
References
90
Citations by year
2026: 25 · 2025: 57 · 2024: 44 · 2023: 40 · 2022: 52 · 2021: 40 · 2020: 38 · 2019: 27 · 2018: 7
FWCI
5.14
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Commonwealth Fund
  • B. Braun-Stiftung
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
shared decision-making, implementation barriers, organizational characteristics, organizational leadership, organizational culture, clinical guidelines, incentives, decision aids, implementation strategies, usual care, implementation facilitators
MeSH terms
Adult, Child, Decision Making, Decision Support Techniques, Female, Health Plan Implementation, Health Policy, Humans, Leadership, Male, Motivation, Patient Participation, Pregnancy, Professional-Patient Relations, Organizational Culture

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