Hovland Runar Tengel, Moltu Christian
1Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.
Department of Psychiatry, District General Hospital of Førde, Førde, Norway.
Int J Ment Health Syst. 2019 Nov 2;13:68. doi: 10.1186/s13033-019-0324-5. eCollection 2019.
Although substantial empirical research supports the clinical value of routine outcome measures/clinical feedback systems (ROM/CFS), translation into routine practice poses several challenges. The present case study investigated how stakeholders, clinicians, patients and clinical managers related to the implementation of the Norse Feedback (NF) in ordinary practice.
We did an in-depth qualitative case study of the implementation of NF in a public mental-health institution. The settings were two outpatient clinics and two in-patient clinics organized under the same health trust. Data were drawn from three sources: archival sources (n = 16), field notes (n = 23), and 43 in-depth interviews with clinicians (n = 19), clinical managers (n = 5) and patients (n = 12). Ten of the participants were interviewed twice. The data were coded inductively and analyzed using a stringent qualitative methodology.
We present our findings under three inter-related domains. First, we describe what followed the clinical feedback implementation. Second, we present the context experienced as being complex and high on work-pressure. Third, we describe the situated rules about the priority between competing tasks.
The preliminary results complement and contextualize understandings of known barriers to implementing ROM/CFS in clinical settings. We apply a socio-material perspective to discuss clinicians' responses to complexity, implementation, and why some incentivized tasks prevailed over others regardless of therapists' perceived benefits.
尽管大量实证研究支持常规结果测量/临床反馈系统（ROM/CFS）的临床价值，但将其转化为常规实践面临诸多挑战。本案例研究调查了利益相关者、临床医生、患者和临床管理人员在普通实践中与挪威反馈（NF）实施的相关情况。
我们对一家公共心理健康机构中NF的实施进行了深入的定性案例研究。研究场所为在同一健康信托机构下组织的两家门诊诊所和两家住院诊所。数据来自三个来源：档案资料（n = 16）、实地记录（n = 23）以及对临床医生（n = 19）、临床管理人员（n = 5）和患者（n = 12）进行的43次深度访谈。其中10名参与者接受了两次访谈。数据采用归纳编码，并使用严格的定性方法进行分析。
我们在三个相互关联的领域呈现研究结果。首先，我们描述临床反馈实施后的情况。其次，我们介绍所经历的复杂且工作压力大的背景。第三，我们描述关于相互竞争任务优先级的既定规则。
初步结果补充并结合了对临床环境中实施ROM/CFS已知障碍的理解。我们运用社会物质视角来讨论临床医生对复杂性、实施的反应，以及为何某些激励任务无论治疗师认为的益处如何都比其他任务更占优势。
