Assess Location & Team
Next, consider some key features of your clinic or department.
- Map out the current patient flow. This may seem obvious but you might be surprised to find out how many steps are involved from making the appointment to completing the appointment. For example, does your patient normally get a reminder call or reminder mailing about their appointment? This may be an opportunity for screening. Does your patient have their vital signs checked in a private room or in a common area? These privacy issues may influence whether you choose a face-to-face or self-administered screen.
- Who normally interacts with the patient beyond the physician? This is the human part of the patient flow map mentioned above. If you can identify all those team members who have interaction with the patient, you can better plan for every team member to take part in planning and delivering SBIRT, even if it just having the front desk person smile and say “thanks” for filling out a written screening. All these little details can impact the attitude the patient has about being asked and given feedback on their substance use.
Finally, identify, understand, and engage your healthcare team
- What role does each team member play in caring for your patients? It may sound strange, but each team member from the front desk to the phone room may not see their role in the same way as you or the clinic management does. Do they see themselves as part of a team with the same mission or do they see themselves as a worker on an assembly line who never gets to see the finished product. Laying the groundwork of defining your team and their roles as individuals as well as their part in comprehensive patient care may be necessary before going forward.
- What are their attitudes toward asking “personal” questions about substance use? Some organizations have begun their implementations by first discussing team members’ personal attitudes towards substance use to help them overcome a feeling of resistance or discomfort about asking about use when they themselves use various substances. Adopting the right attitude toward your team can help them adopt the right attitude toward your patients. In other words, if SBIRT champions within the clinic or organization focus more on improving patient health by reducing risky behavior rather than eliminating it, this may be a more adoptable approach for your staff who may not feel that they are in a position to “judge” patients based on their own imperfect health behaviors. Additionally, sharing data that moving patients toward less risk (rather than no risk) can help. One major study that shows this approach can work is The Cutting Back Study (http://www.health.ny.gov/professionals/ems/state_trauma/docs/cutting_back.pdf )
- What resources do you have at the ready to begin screening, brief intervention and referral to treatment? You can begin with identifying technical support: do you have EMR or other technical support to implement or capture screening data?
Further, you can determine what human resources you have: do you have staff who are already about to do screening or brief intervention? Do you have someone in- or outside of your clinic who can train your staff to do screening and/or brief interventions? Do you have referral support for those who need further, more specialized intervention?
Note, if you did a really thorough assessment earlier in preparation for starting things up, you may already know a lot about these areas. That’s great!
What’s next? You need a plan!
That’s where design comes in…