Clinician Perspectives on Measurement-Based Care to Inform Pre-Implementation Training and Workflow Design on an Adolescent Psychiatric Inpatient Unit.

Abstract

Background: Measurement-based care (MBC) in an inpatient psychiatric setting is uncommon.

Objective: Our aim was to understand clinician pre-implementation attitudes about MBC to optimize workflow and training for MBC implementation in an adolescent inpatient psychiatric unit.

Method: We assessed clinician attitudes toward MBC prior to implementing it in a real-world clinical setting using interviews and a survey. Qualitative interviews were analyzed using the Consolidated Framework for Implementation Research (CFIR) and then mapped to potential solutions via the CFIR-to-ERIC (Expert Recommendations for Implementing Change) matching tool. These results, combined with the survey responses, informed MBC training and workflow design. We then re-assessed MBC attitudes with a post-training survey.

Results: The top CFIR barriers emphasized: 1) measure compatibility with unit context, 2) advantage and priority of the measure, 3) evidence strength and quality of MBC, and 4) existing beliefs about MBC. These barriers were mapped to potential implementation strategies via CFIR-to-ERIC matching tool. Top solutions informed an MBC workflow, clinician training, and a pre- and post-training survey. Identified workflow and training strategies included a need to prepare MBC champions, assess clinician readiness, and conduct training. The pre-training survey showed that clinicians strongly agreed with the rationale for MBC, moderately agreed that MBC would promote patient progress, and less strongly agreed that MBC could be feasibly added to their workloads. Post-training survey findings reflected continued high interest in MBC, an increase in attitudes that MBC could promote patient progress, and an increase in feasibility attitudes, though time constraints remained a concern.

Conclusions: An MBC training and workflow were tailored to incorporate these findings. Pre-implementation attitudes toward MBC critically informed workflow and training development and should be considered in the implementation phase. Specific challenges when implementing MBC within a diverse safety net adolescent inpatient setting are discussed.