Barriers and Enablers to the Implementation of Patient-Reported Outcome Measures Within Cardiff and Vale University Health Board: A Qualitative Study of Healthcare Professionals' Perspectives.

Background Healthcare has experienced a shift towards outcomes-driven care. Patient-reported outcome measures (PROMs) have gained popularity as a means to achieve this goal. Cardiff and Vale University Health Board (CAVHB) is one of the seven Health Boards in Wales that has implemented PROMs in clinical care. The aim of this research was to establish the barriers and enablers that occur across the different levels (micro, meso, and macro) of the Health Board from the perspective of staff engaged in implementing PROMs. The intention is that this will provide useful insights into the important factors to consider when implementing PROMs within a healthcare setting. Methodology A survey on Microsoft Forms (Microsoft Corporation, Redmond, Washington) was created and sent to healthcare professionals from various departments working with PROMs in CAVHB. Multiple open-ended questions were posed to establish macro-, meso-, and micro-level enablers and barriers in the local context. Thematic analysis was carried out to generate a number of barriers and enablers from the responses. Results Sixteen responses were generated from a mixture of departments and disciplines. Frequently reported facilitators included the presence of a specialist Value-Based Healthcare (VBHc) and PROMs team, enthusiastic and motivated clinicians, and adequate education for patients and clinicians. The responses highlighted supportive organisational leadership and the importance of adequate resourcing for implementation efforts. IT systems and digital platforms, when poorly optimised and integrated, can act as a barrier, promote clinician fatigue, and make it difficult for patients to navigate and complete PROMs. Digital illiteracy can act as a significant barrier for segments of the population. This particularly impacted the elderly, who often lacked the ability to confidently engage with digital resources. Conclusion Successful implementation of PROMs must consider a number of barriers and enablers. Education is of key importance and can help mitigate several barriers that may impact clinician and patient involvement in using PROMs. IT systems must be created in a way that links with existing record systems and does not add an additional burden to clinicians. They must be easy to navigate and use for both patients and staff. Organisational buy-in is important, and adequate resourcing and staffing can help facilitate PROMs implementation.