The Institute of Medicine reported that it typically takes 17 years for healthcare innovations to reach the average patient.1,2 The truth is that practice change, whether individual or organizational, is quite challenging. These challenges can include:
- figuring out where to start and how to plan for implementation
- operationalizing the key components
- adapting the key components to fit your organization’s work flows
- engaging a psychiatric consultant
- training the team
- measuring whether the program is achieving its goals
- making course corrections based on experience
For more than six years the AIMS Center has helped diverse clinicians and healthcare organizations implement integrated mental health care programs. We have trained over 3,500 clinicians and have provided implementation support to over 250 organizations, large and small. Those experiences have taught us quite a lot about what does and doesn’t work when planning and implementing an integrated mental health care program.
The tools offered here are designed to help you plan and implement a successful integrated care program.
Step 1: Implementation Timeline
The purpose of the implementation timeline is to help you make an overall plan and timeline. We have learned through experience that training staff is necessary but not sufficient. To be successful, there are several steps that come before staff training and several steps that follow. The implementation timeline shows these step-by-step.
Step 2: Introducing Integrated Care
It is important to introduce the concept of integrated care to everyone in the organization who may be affected by the practice change. This includes organizational leadership, clinicians, clinic support staff and administrative staff. Implementing an integrated care program will affect all of them and the program is more likely to succeed if none of the stakeholders are blind-sided by the implementation. It is also important to be specific about what integrated care is and what it is not. “Integrated care” is a broad term that can mean different things to different people. Get specific about the key components of an evidence-based integrated care program.
Slides (pdf)
Contact us to schedule a live webinar tailored to your organization
Step 3: Team Building
Integrated care can require healthcare professionals to function outside the traditional roles they were trained for and to which they are accustomed. With integrated care, clinicians rely on other team members in a way that may be new or may not be comfortable. This is important to consider when recruiting team members for these roles.
Specific components of the program that may be new and require adjustments to existing work habits:
- proactive follow-up with patients (not waiting for the patient to show up in the clinic)
- routine measurement of depression symptoms with a tool like the PHQ-9
- retiring and changing the treatment plan after 10-12 weeks if the patient’s symptoms are not at least 50% improved
- commitment to evidence-based counseling techniques
The success of any integrated mental health program relies on each of the treatment team members to understand their role, understand the role of other team members, and feel comfortable that they have the knowledge and skills necessary to fulfill their role.
The purpose of the team building worksheets is to identify:
- how many of the key components of integrated care are already in place at your organization
- which components are missing
- which components may be duplicated across multiple team members
- which team member is best suited to be responsible for specific components
- whether the team members feel they have the training and tools they need to be successful
Team Building Worksheets Introduction to Team Building (pdf) |
Job Descriptions Care Manager job description (pdf) |
Step 4: Implementation Planning
Creating a specific implementation plan based on the outcome of the team building process is the next step. The implementation plan should address each step on the Implementation Timeline and use information from the Team Building process to create a specific and detailed plan. To be successful, the person creating the plan should have a thorough understanding of the organizational culture, norms and work flows.
Step 5: Training
After developing a detailed implementation plan it’s time to train the team members. The AIMS Academy offers tailored on-site trainings, training conferences, and case-based training in specific clinical skills. The IMPACT Implementation Center, which is part of the AIMS Center, also offers in-person training and a comprehensive free online training program. CEU are available for most trainings.
Step 6: Monitoring Outcomes
During the planning process it is important to identify specific, quantifiable goals for the program and a plan for how you will collect that information. After the integrated care program has been in place for a few months it is a good idea to look at the goals and progress toward them. This process often identifies issues that can be addressed early on before becoming institutionalized. Periodic check-ups are recommended to keep the program on track. The AIMS Center has extensive experience with program evaluations and health services research. If you are interested we can provide technical assistance in this area.
1Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics. 2000;65–70.
2Committee on Quality of Health Care in America, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.