Communication strategies to facilitate the implementation of new clinical practices: a qualitative study of community mental health therapists.

Although communication is widely observed to be central to the implementation process, the field of implementation science has largely overlooked the details of how communication may best be utilized to facilitate implementation. This paper draws on relevant insights from Rogers' Diffusion of Innovations Theory, which laid the foundation for explicitly attending to the role of communication as a mechanism for implementation strategies to exert their effects. To offer empirically-derived and theory-informed recommendations regarding communication processes to support the effective introduction of new clinical practices. This investigation leverages data from 61 therapists poised to undergo implementation of measurement-based care (MBC) for depressed adults receiving psychotherapy in community mental health settings. Data were collected via focus groups across 12 sites. Themes emergent in the data analysis suggest five practices to facilitate effective communication in the introduction of new clinical practices like MBC: the communication of a clear rationale for the new practice; the provision of necessary procedural knowledge; communication about the change via multiple methods; sufficient lead time to prepare for the change; and the opportunity for bidirectional engagement. In addition to indicating several best practices to improve communication prior to implementation, our results suggest that the current conceptualization of implementation strategies may not yet be complete. Components and/or methods of effective communication about new practices should be included among the growing set of implementation strategies. Existing implementation strategies might also benefit from more temporal specificity, with more attention to the exploration and preparation phases. (Trial Registration: Clinicaltrials.gov NCT02266134. Registered 12 October 2014.).

There has been a great deal of attention recently to the study of implementation, or how something (e.g., a new clinical practice or initiative) is actually put into effect. Many studies have found a number of barriers to and facilitators of the implementation process. But despite this increased attention, the field of implementation science may not have paid enough attention to the role of communication. Although communication is generally acknowledged as important, precisely how it impacts implementation­and, importantly, the ways it might be improved­is typically unexplored. This study conducted focus groups with mental health therapists in 12 clinics which were about to implement a new clinical practice: measurement-based care for depressed adults receiving psychotherapy. What these therapists shared about their perspectives and experiences suggest that there are at least five ways to facilitate effective communication when introducing a new clinical practice: communicating a clear rationale for the new practice, providing necessary procedural knowledge, using multiple methods to communicate about the change, giving sufficient lead time to prepare for the change, and providing the opportunity for bidirectional engagement.

How Do Peers Shape Mental Health Clinicians' Attitudes Toward New Treatments?

Through everyday interactions, mental health clinicians are exposed to their colleagues' views toward new treatments, which can influence clinicians' own attitudes and implementation especially in high-stress environments. This study examines how exposure to peers' attitudes in the workplace through three common workplace interactions (advice sharing, discussion, and friendship) shapes clinicians' (n = 163) own attitudes toward measurement-based care (MBC). Clinicians tended to have more positive attitudes toward MBC with greater exposure to peers with positive attitudes through advice-sharing and informal workplace discussions, but not through friendships. Results highlight the importance of strong workplace relationships for implementation.