164 Chapter 6 Table 2. (continued) CFIR domain CFIR barrier What is already done? Why still a barrier? Inner setting 7. Compatibility • At the start of the KLIK implementation, the KLIK expert team advices on how to fit KLIK best into the existing workflow • Recently, in four hospitals, a front-end integration with KLIK and the EHR (Epic© and HiX©) is realized A study showed that a perceived barrier for stakeholders was compatibility (24% of clinicians indicated that the KLIK method did not fit well with current routines) [29]. To make it better fit with existing workflows, KLIK should be integrated into the EHR in all hospitals Inner setting 8. Organizational incentives & rewards • Clearly communicate incentives (e.g. communication tool, improvement of quality of care, data can also be used for scientific purposes) of using PROMs in clinical practice for both patients and clinicians Sometimes there are no incentives in the opinion of multidisciplinary teams and they, therefore, do not promote the use of PROMs in clinical practice Inner setting 9. Leadership engagement • License agreements are signed by an authorized signatory and it therefore approves the implementation Key organizational leaders or managers could show more commitment and involvement in KLIK by promoting it actively. In addition, in the current situation, they are not held accountable for implementation of the innovation Inner setting 10. Available resources • KLIK has received several grants for the implementation and developed a business model to provide financial resources for the KLIK expert team in addition to the external resources There is no structural funding yet for the KLIK expert team. To continue implementing KLIK, we are currently working on a new business model where we are not dependent on external funds, but can provide the use of KLIK at low costs For clinicians, money or time to discuss PROMs can be a barrier in implementing PROMs Characteristics of individuals 11. Individual stage of change • When clinicians experience benefits from implementing PROMs, they become more enthusiastic • By training clinicians, the skills necessary to implement and discuss PROMs are provided • During the annual evaluation meetings we identify clinicians that do not perceive enough benefits or forget using KLIK. These meetings keep the clinicians focused on the goal of discussing PROMs • From the perspective of patients, information letters, flyers and educational videos are provided to give them the skills to complete and discuss PROMs. In addition, focus groups are held to explore their experiences regarding KLIK, in order to further optimize KLIK Clinicians that do not feel skilled or enthusiastic about using the innovation in a sustained way are resistant to use the intervention. Feedback from patients includes that PROMs are not discussed by the clinician, they sometimes do not see the added value, and PROMs can be long and repetitive
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