. "10 Opportunities for Innovative Reforms and Knowledge Development." Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: The National Academies Press, 2009.
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Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention
websites providing tools and case studies. One relevant example is the link to an AHRQ website detailing the failure of a program that faxed real-time pharmacy data to alert physicians that patients were not complying with their antidepressant medication regimen. An evaluation found that the critical programmatic weakness was a failure to train physicians and nurses in what to do with the faxed information. Nor was there follow-up with the physicians about what they did with the faxed information.
The second core question for potential adopters is “Should we do it here?” Key questions include: What are the benefits? Will these benefits be visible and convincing for stakeholders? What are the necessary resources and costs? Are there potential offsets to the costs, and what is the opportunity cost associated with adopting the innovation? How does one prepare a business case? How can potential risks be assessed? Links are provided, for example, to websites containing tools and templates for assessing risk over different timeframes.
The third core question is: “Can we do it here?” This section focuses on organizational readiness and the willingness of staff to make the necessary changes in what they do. It also considers ways to assess the impact of change on the organization’s stakeholders, such as patients and families, board members, and community partners. What sort of structural, process, and workforce changes will be needed to implement the innovation? Can champions be identified who will promote the innovation by generating enthusiasm, fostering change, bridging communication gaps, and solving problems as they arise? What can the organization learn from its past efforts at adopting innovations? Can we do it in time? Examples include links to websites on how to use Gantt charts to plan and track implementation progress.
The final core question is “How will we do it here?” Key questions include: How should the program be evaluated? What constitutes meaningful measurement of success, and what is the burden of data collection? In response to these questions, links are provided to websites discussing measurement issues as well as to the AHRQ Measures Clearinghouse, a public repository of public domain measures and measure sets. What are the advantages and disadvantages of first trying the innovation for a short period of time or on a small scale? How do we manage change to get staff and stakeholder buy-in? And, finally, how do we sustain an innovation that proves worthy of adoption?
Guidelines such as the AHRQ guide lay out the basic principles, common issues, and first steps that should be considered by planners seeking new programs to address unmet needs. However, the generic nature of such guidelines means that potential adopters must creatively interpret their application to specific programs and settings. Indeed, most evidence-based and promising depression care programs lack detailed implementation manu-