Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams

Bunniss, Suzanne; Gray, F. Elizabeth; Kelly, Diane

doi:10.1111/j.1365-2753.2011.01641.x

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…This research also found that sites with external facilitation were appreciative of the time and expertise provided by the facilitators. This finding supports that of Bunniss et al [ 17 ] that the value of the external facilitators became apparent to the participant after the first facilitation session, and their contributions were recognized by teams as valuable.…”

Section: Discussionsupporting

confidence: 91%

“…To improve the quality of acute stroke services [ 11 ] in the Veterans Health Administration (VHA), the VA stroke Quality Enhancement Research Initiative (QUERI) [ 12 ] partnered with VA Center for Applied Systems Engineering (VA-CASE) [ 13 ], an interdisciplinary Veterans Engineering Resource Center (VERC) to provide industrial/systems engineering facilitation and tools to evaluate a stroke learning collaborative [ 14 - 16 ] intervention. Given the complexity of the acute stroke clinical practice changes and the training literature [ 16 ], the collaborative program training [ 17 ] alone is insufficient to produce and sustain practice changes [ 18 ]. Therefore, telephone facilitation is an important and efficient approach to provide facilitation service [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration

et al. 2015

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BackgroundFacilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement.MethodsWe conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators.ResultsThe external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach’s role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not an event but rather a process where relationships and responsibilities evolve over time.ConclusionsThis study shows that external facilitation involves core elements related to communication, relationship building, methods training, monitoring performance over time, and facilitating team-based problem solving. Importantly, this work demonstrates the fluid nature of external facilitation over time, as teams learn, grow, change, and experience changing contexts.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0252-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration

et al. 2015

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“…Other studies have found that working towards shared goals can break down barriers between professional groups and enhance communication within practice teams. 20,21 The study presented here suggests, however, that pre-existing effective communication has helped to embed this new approach to collecting patient feedback within general practices.…”

Section: Comparison With Existing Literaturementioning

confidence: 90%

Capturing patient experience: a qualitative study of implementing real-time feedback in primary care

et al. 2016

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“…One research study showed that applying learning theory to clinical practice teams using facilitated sessions led to successful outcomes for change management. 30 These facilitated activities set the stage for valuable discussion, exchange of experiences, insights, and inquiry surrounding both individual and group ideas for the transition that needs to occur to realize a new care delivery vision.…”

Section: Qsen Competenciesmentioning

confidence: 99%

Patient and Family Engagement Summit

Swartwout

Drenkard

McGuinn

et al. 2016

JONA: The Journal of Nursing Administration

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Patient and family engagement is a strategy to enhance healthcare outcomes through strong clinician-patient partnerships. A new care delivery process, in which the patient is the driver of the healthcare team, is required to achieve optimal health. A summit partially funded by a seed grant from the Robert Wood Johnson Executive Nurse Fellow Alumni Foundation was held with interprofessional colleagues and patient representatives to identify needed clinical competencies and future practice changes. Recommended shifts in the care delivery process included a focus on patient strengths, including the patient as a valued team member, doing care "with me" and not "to me," and considering all entities or providers including the patient, as equal partners.

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Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams

Cited by 17 publications

References 21 publications

Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration

Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration

Capturing patient experience: a qualitative study of implementing real-time feedback in primary care

Patient and Family Engagement Summit

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