Implementing Open Dialogue approaches: A scoping review

Abstract

Open Dialogue approaches fall broadly into the area of systemic psychotherapeutic practices. They encourage active participation of families and social networks, and emphasize genuine collaboration within highly integrated systems of health‐care service delivery. These approaches are currently being implemented in a growing number of services across the globe, and in this review, we summarize and discuss insights from papers concerned with the implementation of Open Dialogue. We used a scoping review method, which included systematic literature searches and summarizing data extraction as well as consultation with eight Open Dialogue implementation stakeholders who were invited to comment on preliminary review findings and a draft paper. We included 18 studies in the review and present their content under four thematic headings: 1. Training, 2. Family and network experiences, 3. Staff members’ experiences, and 4. Structural and organizational barriers and resistance to implementation. In general, the studies did not include rich descriptions of the implementation contexts, which made it difficult to draw conclusions across studies about effective implementation practices. The discussion draws on Jamous and Peloille’s (Professions and professionalisation, 1970, Cambridge University Press, 109‐152) concepts of “indeterminacy” and “technicality,” and we argue that the indeterminacy that dominates Open Dialogue is a challenge to implementation efforts that favor specific and standardized practices. We conclude by encouraging the development of implementation initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental spirit of the approach.

Introduction: Open Dialogue around the world – implementation, outcomes, experiences and perspectives

“…This Research Topic pays attention to the fact that Open Dialogue services have been investigated through a range of research methodologies (Freeman et al, 2019 ; Buus et al, 2021 ), including multi-site observational studies used to test feasibility and efficacy (Harding et al, 1987 ; Seikkula et al, 2006 ). Open Dialogue experiences and outcomes have been studied through various survey instruments, including service-user (and family/social network member) self-report scales (e.g., quality of life, or perceived satisfaction with network sessions/service in general).…”

“…This challenges conventional ideas on the source of clinical knowledge and definitions of expertise, changing established professional self-understandings and claims (von Peter et al, 2021 ). There are implications for clinical governance including responses to risk, clinical note-taking, discharge, flexible working and the boundaries around clinical work, as well as for training and supervision (Buus et al, 2021 ).…”

Organizational Change in Complex Systems: Organizational and Leadership Factors in the Introduction of Open Dialogue to Mental Health Care Services

“…For several decades, Open Dialogue approaches have been implemented in health care and social care sites across the world (Buus et al, 2017 , 2021 ). Scandinavian implementation studies indicate that adoption of Open Dialogue – like any other organizational change – can generate organizational, professional, and personal resistance which may compromise the core Open Dialogue principles and methods offered at a given site (Brottveit, 2013 ; Søndergaard, 2009 ).…”

“…An Australian study of implementation of Open Dialogue in a private healthcare setting observed tension at the boundaries of organizational systems, challenges between core clinical values, and conflicting expectations of professional practice and performance (Dawson et al, 2019 ). A recent ‘scoping review’ (Arksey & O’Malley, 2005 ) of Open Dialogue implementation studies (Buus et al, 2021 ) found that published studies did not include rich descriptions of the organizational implementation contexts (for instance culture, resourcing and management/leadership factors) or the organizational strategies for the implementation, which made it difficult to draw conclusions regarding what types of implementation would be more effective than others, and under what circumstances. Further, the review highlighted the implementation challenges linked to the flexible and needs-adapted character of the approach that gives it a spirit of indeterminacy (Buus et al, 2021 ).…”

“…A recent ‘scoping review’ (Arksey & O’Malley, 2005 ) of Open Dialogue implementation studies (Buus et al, 2021 ) found that published studies did not include rich descriptions of the organizational implementation contexts (for instance culture, resourcing and management/leadership factors) or the organizational strategies for the implementation, which made it difficult to draw conclusions regarding what types of implementation would be more effective than others, and under what circumstances. Further, the review highlighted the implementation challenges linked to the flexible and needs-adapted character of the approach that gives it a spirit of indeterminacy (Buus et al, 2021 ). Open Dialogue is not a manualized treatment method, which can generate tensions in organizational implementation contexts that generally favor specific and standardized practices, such as fidelity measures and manualized protocols for practice (Waters et al, 2021 ).…”