Conduct an environmental analysis to identify barriers and facilitators

An environmental analysis identifies and assesses organizational and other factors that can act as barriers or facilitators to development and implementation of your proposed decision support solution.

How:

Encourage the members of your guiding coalition to use their experience, networks and contacts to identify factors and initiatives that could either support or detract from successful delivery and implementation of decision support.

Barriers are factors that negatively influence the acceptance of DSS or its advice, eg. lack of trust, or poor DSS performance or advice that is not evidence-based. Facilitators encourage the acceptance of a DSS, eg. senior-level organisational support; communication; engagement of champions; user involvement; eHealth support- see Section 3.3.

For example, workforce development and education around type 2 diabetes prevention can serve as facilitators to strengthen implementation of preventative decision support tools. Conversely, pressures on staff time and services as a result of service demand and other change initiatives may act as barriers to engaging key stakeholders in implementing decision support tools that require a change in workflow or service model.

Many barriers to the adoption of decision support and methods to overcome them have been identified from both qualitative studies and quantitative surveys or analyses of DSS usage data. See Section 3.3 for a list of some of these, organised using a widely accepted framework, the “Five Rights” framework [Osheroff 2012].

One commonly used technique to carry out environmental analysis is SWOT analysis - listing out the Strengths and Weaknesses of the project (in this case, building the DSS), together with (external) Opportunities or Threats that may affect it.

Why:

You can use insight into specific barriers and facilitators to support your selection of decision support interventions that have the greatest likelihood of success. They should also be a key part of your planning of development and implementation, so that you address barriers and include facilitators to maximise the impact of your decision support tool.

In a classic systematic review of 100 RCTs of different methods used to improve clinical practice, Davis showed that these methods were more likely to be effective if they were chosen following a careful analysis of local barriers to adoption of that practice [Davis et al 1995]. Westerbeek [Westerbeek 2021] confirmed that a list of common barriers and facilitators is valuable to guide the design and implementation of DSS, but emphasised that it is no substitute for the involvement of users in the development process.