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The adoption of shared decision making (SDM) into routine practice is all too often elusive.  Even though SDM is the foundation for patient-centered care, its implementation can be a challenge as a result of numerous barriers. 

Understanding SDM

SDM happens when patients and their providers work together to determine the best path of medical treatment for each patient. This process involves a clinician sharing all available options and then helping the patient evaluate these options and weigh their personal values and goals to make informed decisions. 

Establishing this open dialog between patients and providers to discuss possible treatment options and potential outcomes is fundamental to safe, effective, and compassionate health care. 

Recognizing that SDM is the foundation of patient-centered, high-quality care, many health care organizations are implementing SDM processes to improve patient outcomes. If you are considering (or struggling with) implementing an SDM initiative, here are five steps your organization can take to help ensure its success. 

Build Your Case

SDM is a patient-centered intervention that brings numerous benefits to providers, patients, and health care organizations. Carrying it out requires a shift in mindset from all levels of the organization, in essence, adaptive change is what is needed. To be effective, senior leadership, management, and care teams will need to support the SDM initiative and promote best practices. Building a case for the program is essential to getting everyone on board.

 Key benefits that will build your case for SDM implementation include:

• With SDM, patients are more informed, engaged, and activated
• SDM aligns with many quality initiatives and regulatory requirements
• SDM is an evidence-based practice
• SDM helps improve the patient-clinician therapeutic relationship
• SDM helps lead to better utilization of health care resources
• SDM leads to a reduction in health care disparities
• SDM has a positive impact on quality, cost and safety of care delivery

Develop an Implementation Team

Once you have the necessary buy-in, it is time to appoint your SDM implementation team. The team will be responsible for engaging providers, staff, and patients in the SDM process so that it becomes part of routine practice. Ideally, the team will be made up of a mix of staff with different health care roles; for example: physicians, educators, nurses, administrative personnel, front desk personnel, social workers, members of the ethics consult team, and pharmacists. Identifying champions to drive the initiative will be crucial to its success. 

Responsibilities of the implementation team typically include:

• Developing a SDM workflow process;
• Choosing educational and patient decision aid materials;
• Conducting clinician and staff training; &
• Monitoring initiative progress

Define The Process

The next step is to lay out an SDM process that makes sense for your practice or organization. Whether starting small with a pilot within one clinical unit or implementing an organization-wide initiative, it will be important to follow best practices for effective SDM. 

These best practices include:

• Assessing and addressing patient values, preferred language, and health literacy needs;
• Practicing active collaboration;
• Providing evidence-based, high-quality, and certified patient decision aids; &
• Streamlining the SDM process into daily workflows

Educate All Members of the Care Team

Education is an essential step in implementing an effective SDM process and promoting positive attitudes toward the new initiative. Each staff member who interacts with patients should not only understand the value of SDM, but also his or her role in the process. Education can take the form of staff meetings, in-service days, workshops, coaching, CME/CNE activities, webinars and/or video training modules. 

SDM training may encompass:  

• How to practice SDM;
• Collaborative communication skills;
• Role-playing dialogue with patients;
• Documentation of SDM; & 
• Integrating SDM and decision-making tools into daily workflow

Measure, Monitor, and Evaluate

As with any quality improvement initiative, you should determine the desired results and identify how to measure success. It is important to set realistic goals and recognize success, which will help maintain motivation among the clinical team. Tracking the performance of the initiative will enable the SDM team to develop solutions to improve outcomes, when needed. 

Examples of metrics to monitor: 

• Patient satisfaction and/or engagement;
• Provider feedback;
• Referrals to supportive care;
• Rates of patient decision aid use;
• Readmissions;
• Patient compliance; &
• Reduced costs

Find more resources for shared decision making here.

ACP Decisions is dedicated to empowering patients, families and health care providers in advance care planning. Our extensive library of evidence-based video decision aids includes education about care options for patients with advanced illness. If you’d like to learn more or sign up for our monthly newsletter, please contact us!  

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