Implementing SBIRT across an organization is challenging but it is also very worthwhile. You will encounter barriers and you will have to change how you think you are going to do things in order to be responsive to the people in your organization, both patients and providers.
Some of the key things from our efforts include, according to the project lead, Dr. David Crabb:
“One of the things that really increased our likelihood of success was that we had buy in from top to bottom. From the department of medicine, to the mental health system at Midtown, and the leadership of Wishard hospital, everyone became invested in the implementation. We also had a health system partner in Wishard that was already involved in population health before that term became popular, so this was a natural transition for them. Finally, we provided excellent face to face training, with a great motivational interviewing trainer, and ongoing support and check-ins.”
“One thing we found most challenging was the changing nature of the EMR, and competing demands on it that evolved during our period of support. One would think you would have a form and be able to make it electronic, no problem, but systems change, processes change, and this was ongoing during our effort. Other areas we should have paid more attention to included documentation of the screening efforts early on in the process and recognizing earlier than we did that physician (resident) follow through on positive screens was low. In retrospect, we would probably start smaller and do it in a more focused way: perhaps train all of the physicians working in a smaller clinic at once, and then implement that screening; instead, we chose to train all our residents based on the timing of an outpatient education block even though many didn’t work in the clinic in which SBIRT was being introduced. We let timing and convenience rather than need drive education, and that was a mistake.”
“In the end, across the board, we had excellent champions for the process and considerable buy in from many stakeholders. This is the one thing that likely most supported success despite challenges and barriers. Well, this, and a lot of hard work!”
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