Create a Team
Once you have done the organizational assessment, you should have some help.
Seriously. You’ll need help. And, from the assessment, you probably already identified a few compatriots to assist you.
At this point, you need a general idea of what you want to do. This doesn’t have to be detailed, but you should have enough of a idea to be able to convey what you are up to to others who you’ll need from whom you’ll need support. What are you up to, how do you think you will approach it, and why should others care?
And, you really need to get buy-in at the top if you hope to get very far.
Sure, you could decide that you will use a screening instrument, say the AUDIT questionnaire, with your patients and provide BI when needed. But how will the screening result be kept in the medical record, aside from your office note? If you detect worrisome levels of use or suspect dependence, to whom will you refer the patient and how will you ensure effective collaboration with the addiction specialists? The point is simply that public health measures like SBIRT really benefit the patients when broadly implemented. Plus, everyone’s experience with change is that you WILL encounter resistance, problems with implementation, and you will need resources!
If the solo act described above is all you can do, by all means do it! Because something is better than nothing, and maybe that little solo act can snowball into a much bigger production but let’s shoot for the whole enchilada (to fully mix multiple metaphors!)!