Role of “external facilitation” in implementation of research findings: A qualitative evaluation of facilitation experiences in the Veterans Health Administration

Implementation Science (Impact Factor: 4.12). 02/2006; 1(1):23. DOI: 10.1186/1748-5908-1-23
Source: PubMed


Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system - the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs.
A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis.
Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other implementation interventions, while performing this problem-solving and supportive role. PRELIMINARY CONCLUSIONS: This evaluation provides evidence to suggest that facilitation could be considered a distinct implementation intervention, just as audit and feedback, educational outreach, or similar methods are considered to be discrete interventions. As such, facilitation should be well-defined and explicitly evaluated for its perceived usefulness within multi-intervention implementation projects. Additionally, researchers should better define the specific contribution of facilitation to the success of implementation in different types of projects, different types of sites, and with evidence and innovations of varying levels of strength and complexity.

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Available from: Jo Rycroft-Malone
    • "External facilitation is defined in the Promoting Action on Research Implementation in Health Services (PARIHS) framework as an interactive problem solving and support process that occurs in the context of a need for improvement and support (Stetler et al., 2006; Kitson et al., 1998). However, internal facilitation is not explicitly defined in the model (Stetler et al., 2006). See "
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    ABSTRACT: Although the literature has noted the positive effects of facilitation in implementation research, little is known about what facilitators do or how they increase adoption of a program. The purpose of this study was to understand internal facilitation activities in implementing a national safe patient handling program from the perspective of facility coordinators who implemented the program. Using a qualitative descriptive design, data were collected in five focus groups at two international Safe Patient Handling and Mobility Conferences. Participants were 38 facility coordinators implementing a safe patient handling program in the Department of Veterans Affairs medical centers throughout the United States. Data were analyzed using direct content analysis to gather descriptions of internal facilitation. The internal facilitation process involved engaging multiple disciplines and levels of leadership for implementation. Fifty-four facilitation activities were identified, including five activities not currently listed in an existing taxonomy. Key characteristics and skills of facilitators included persistence, credibility and clinical experience, and leadership and project management experience. Themes were mapped onto an existing framework and taxonomy of facilitation activities. Internal facilitation is both an implementation intervention and a process involving a wide range of activities. The findings provide an understanding of what internal facilitators are doing to support practice changes and the characteristics and skills of internal facilitators that are likely to result in long-term organizational change. Five recommendations for action address organizations, senior leaders, and internal facilitators. © Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
    No preview · Article · Jul 2015 · Worldviews on Evidence-Based Nursing
    • "The facilitator serves as a catalyst by stimulating clinicians' reflections about their own practices and the necessary changes. Recently, research demonstrated the benefit of using an EF, an internal facilitator, or both (Dogh­ erty, Harrison, Baker, & Graham, 2012; Stetler et al., 2006). Facilitated teambased reflection or having a physician and nurse champion implementation of clinical practice guidelines (Shaw, Howard, Etz, Hudson, & Crabtree, 2012; Sipila, Ketola, Tala, & Kumpusalo, 2008) can be helpful in overcoming barriers to collaboration. "
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    ABSTRACT: Implementing interprofessional collaborative practices in primary care is challenging, and research evidence on its facilitating factors remains scarce. The goal of this participatory action-research study was to better understand the driving forces during the early stage of the implementation process of a community-driven and patient-focused program in primary care. Findings from intra and inter-case analyses revealed three key forces that were perceived as driving the early phase of the implementation process: 1) Open space for dialogue through IFT; 2) Active roles of EF; and 3) Secured and planned change implementation budgets. Decision and policy makers designing implementation plans for interprofessional programs should ensure those driving forces are activated. Further research should investigate how these driving forces impact interprofessional practices and patient outcomes.
    No preview · Article · Jul 2015 · Journal of healthcare management / American College of Healthcare Executives
    • "sie in der Dimension «Unterstützung» , einen hohen, jedoch keinen signifikanten Einfluss auf die Forschungsanwendung nachweisen. Die Wichtigkeit einer adäquaten und umfassenden Unterstützung für eine gelungene Forschungsanwendung wird auch in weiterer Literatur bekräftigt (Kitson et al., 2008; Stetler et al., 2006). Zu unterstützen bedeutet, eine vielfältige Rolle zu übernehmen, die mehr ist, als jemandem eine neue Pflegetechnik zu lehren (Stetler et al., 2006), denn Forschungsanwendung umfasst alle Hierarchiestufen (Harrison & Graham, 2012; Estabrooks et al., 2007). "
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    ABSTRACT: Hintergrund: Hinter der konkreten Anwendung von Forschungsergebnissen in der pflegerischen Praxis steht ein mehrdimensionaler Prozess. Derzeit liegen in Österreich noch keine Ergebnisse vor, die den Einfluss auf und den Zusammenhang mit Forschungsanwendung in Krankenhäusern erklären. Ziel: Ziel der Studie war, Einflüsse und Zusammenhänge von persönlicher Einstellung zu Forschungsanwendung, Verfügbarkeit von Forschungsergebnissen und institutioneller Unterstützung von Pflegekräften in Spitälern in Österreich in Bezug auf die Forschungsanwendung zu untersuchen. Methode: Im Rahmen eines nicht-experimentellen quantitativen Querschnittdesigns wurde 2011 eine multizentrische Studie (n = 10) durchgeführt. Ergebnisse: Die Stichprobe umfasst 178 diplomierte Gesundheits- und Krankenpflegepersonen, die mittels Fragebogen befragt wurden. Die multiplen Regressionsanalysen zeigen, dass eine positive Einstellung zu Forschungsanwendung (β = 0,388; p < 0,001), die Verfügbarkeit von aufbereiteten Forschungsergebnissen (β = 0,470; p < 0,001) und eine adäquate institutionelle Unterstützung (β = 0,142; p < 0,050) einen signifikanten Einfluss auf die Anwendung von Forschungsergebnissen haben. Die Pfadanalyse belegt, dass der Besuch von Kursen zu Evidence-based Nursing die Einstellung gegenüber Forschungsanwendung in starkem Maße positiv beeinflusst (β = 0,464; p < 0,001). Schlussfolgerungen: Gesundheitseinrichtungen sind gesetzlich gefordert, vorhandene positive Einstellungen zu nutzen und Unterstützungsmöglichkeiten für eine wissenschaftsorientierte Pflegepraxis zu schaffen.
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