External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change

Abstract

BackgroundFacilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.’s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors.MethodsWe carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group’s site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics.ResultsA non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: “implementation-oriented” and “support-oriented.” Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors.ConclusionsFacilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0458-7) contains supplementary material, which is available to authorized users.

Exploring the Attributes of Exemplary Facilitators in Family Medicine Residencies: Implications for Practice Transformation

“…ORIGINAL ARTICLES I n health care literature, the term "practice facilitator" describes someone who assists clinicians in practice transformation projects. [1][2][3][4][5][6][7][8] These facilitators commonly work toward improving the delivery of clinical interventions, particularly preventive services [9][10] ; facilitating research and quality improvement (QI) projects [11][12] ; and implementing health information technology.…”

Implementing TeamSTEPPS in small rural hospitals

“…This indicates that hospital leaders need to cultivate the right balance of conditions in order to sustain facilitation activities, and not rely on individual factors to drive the processes. Furthermore, these findings highlight the influence of group dynamics on implementation, an area often ignored in the empirical literature (Lessard et al, 2016).…”

“…Furthermore, our post hoc analyses showed that continuity of team leadership also influenced sustainment patterns, where losing a team leader without finding a suitable replacement led to the remaining facilitators adopting a more defensive approach. These findings highlight the need to study change teams more closely (Lessard et al, 2016). Future studies can draw on the extensive team literature to examine the effects of factors such as team composition (Barrick et al, 1998) and shared mental models (Mohammed et al, 2010), which can help explain why some facilitator teams are effective while others are not.…”

“…Facilitators often work as teams (e.g. Dogherty et al, 2010Dogherty et al, , 2012Elnitsky et al, 2015, yet team-level factors are typically not examined in implementation literature (Lessard et al, 2016). We drew on the literature on team viability, which defines it as a capability for sustained performance of the team (Barrick et al, 1998;Bell & Marantette, 2011).…”

“…The complexity and timespan of change processes require continued and persistent effort from facilitators, which is challenging in light of competing demands and limited resources (Dogherty et al, 2013). Furthermore, while the implementation and change literature typically recognizes the role of facilitator teams, the literature rarely accounts for team dynamics in empirical studies of implementation (Lessard et al, 2016). In this paper, we sought to examine the variation in sustainment of facilitation activities and what organization-and team-level factors (as well as their interplay) help account for it.…”