Table 2.

Common themes for transforming opioid therapy with Kotter’s change theory.

Common themes	Description	Action steps	Kotter’s change theory
Provide leadership support	Leadership that can build organization-wide consensus for prioritize safe opioid prescribing.	Identify change agent (coalition team) to spearhead practice change initiatives.	Create a sense of urgency Build a core coalition
Define standard of work	Revise and implement opioid therapy policies and define standard of work for providers and staff to achieve safer opioid prescribing.	Convene team from each clinic department to create and communicate the change initiative. Update patient agreement and revise to ensure alignment with clinic and guideline policies.	Develop a vision and strategy Communicate the strategic vision Empower broad-based action
Conduct pre-visit reviews	Conduct pre-visit planning and screening for comorbidities and prescription aberrancies.	Review outside medical records. Review state prescription monitoring program patient data. Implement new patient exclusion criteria.	Generate short-term wins.
Conduct post-visit reviews	Conduct post-visit chart reviews for opioid outliers.	Monitor and adjust opioid therapy based upon function not pain scale. Conduct team reviews of outliers for consensus of care. Discharge outliers to improve staff efficiencies. Identify referral sources for behavior and mental health (eg, opioid abuse disorder).	Consolidate gains and produce more change.
Measure progress	Continuously monitor progress and improve with experience.	Identify key processes and outcome measures to monitor change implementation. Monitor prescription practices, provide and discussing data with medical providers and support staff at regular meetings (no less then monthly).	Anchor new approaches in the corporate culture.