This is excellent!! We will learn/talk more about the “intervention tool box” next week… but I would also consider including strategies that modify perceived social norms (e.g. posters and newsletters in surgical places/spaces that display SDM as an expected and valued activity).
Another way to think about the social-ecological framework is to consider what are the key “drivers” that support SDM at each level… at individual (surgeon) level, it’s your TPB domains (social norms, professional satisfaction, recognition/rewards; and patient expectations), at the neighborhood/community level it includes awareness and expectations in the community/social environment that SDM is the “best practice”—this can be communicated through patient/professional groups’ materials and advocacy statements, newsletters, websites, etc. At Institution level, the key driver could be response to policies (as you mention), but at the Hospital level it could also be tied to obtaining better contracts with insurance companies and to achieving lower total cost of care when incorporated into a population health/ACO type financial contract. Politics and money also drive the state/national policy levels… politicians respond to key advocacy groups and constituencies, so making SDM a key priority for these groups is important.