The Big Picture: An Overview of DA Implementation


Advanced and thorough planning is important for an effective SDM/DA program that will work for the clinic and translate well for the patients.

Implementation Tasks and Tactics

You can use visual or verbal implementation flow models as you start your planning process using these four steps:

    1. Start your activities by developing a DA implementation team
    2. Schedule an initial DA implementation team meeting and develop a preliminary plan keeping these questions in mind:
      • What DAs should our clinic distribute?
      • Who will identify eligible patients?
      • Where will the DAs be stored?
      • How will DAs be distributed?
      • When do we know if we should expand, change, or refine our processes?
    3. Hold an all-staff kickoff meeting to discuss the project, present implementation plans, and get feedback from staff on the proposed approach.
    4. Refine your plan in real time using Plan-Do-Study Act (PDSA) cycles and team meetings that support reflection and integration of lessons learned.

Supporting Practice Change for SDM/DA Implementation
Practice change takes time, and implementing SDM/DAs might best be accomplished by working out kinks with your DA team before spreading across the clinic.

The DA team should implement a working process to develop and refine standard operating procedures. Identifying the best approach for implementing DAs requires refinement over time based on both successes and failures. We recommend that you plan for small tests of change by scheduling weekly meetings to reflect upon what is working (or not working) at the beginning, less frequent (monthly) as the procedures are streamlined, and then on an as needed basis once the DAs become a routine component of care.

Small Plan-Do-Study-Act (PDSA) cycles can be effective methods for testing intervention changes and identifying effective implementation approaches. Full courses and textbooks are available on PDSA cycles.

Brief introduction to Plan-Do-Study-Act (PDSA) Cycles
The PDSA cycle is a quality improvement approach that allows teams to identify changes, test the changes in real time, reflect on the experience to make improvements, then test changes and repeat the cycle again.
Note: The “Study” component is increasingly called “Check” – resulting in PDCA cycles.

Exploring External Support for DA Implementation and Clinic Change
You may want to consider exploring opportunities for external support for your DA integration project through:

    • Grants available through insurance companies;
    • Technical assistance from regional health extension centers; or
    • Partnerships with Practice-based Research Networks (PBRNs).


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