Facilitation as a component of evidence implementation: a multinational perspective

Self Cite

Objectives: This project determined current compliance with best practice recommendations for self-management in patients with multiple sclerosis (MS) and used a web-based intervention to implement strategies to improve the quality of self-management in discharged patients with MS. Methods: Guided by the JBI Evidence-based Model of Healthcare, this project applied the 7 phases of the JBI Evidence Implementation Framework to improve the quality of self-management in MS patients. Results: After implementation, compliance significantly improved across all criteria compared with the baseline audit. All patients were assessed to determine their ability to self-manage (Criterion 1). All health care providers were trained to facilitate self-management and behavioral change (Criterion 2). All patients had self-management goals and action plans that were set together by both health care providers and patients (Criteria 3, 5, 6, 7). All patients received education through online patient education courses and were given an education handbook (Criterion 4). The agreed action plan was documented (Criterion 8). All members of the multidisciplinary team coordinated the services required by the patients (Criterion 9) and provided appropriate support to help patients achieve their goals and solve problems through a WeChat group and the communication module on the self-management online platform (Criterion 10). Conclusion: This implementation project effectively promoted practice change by enhancing patients’ knowledge of self-management and staff awareness of delivering self-management support to MS patients.

Section: Discussionmentioning

confidence: 99%

Improving the quality of self-management in discharged patients with multiple sclerosis: a best practice implementation project

Xu,

Lizarondo,

Zhao

et al. 2023

Self Cite

“…They leveraged their knowledge of the implementation context's information needs, engagement style, and work structurenuances that are important for successful evidence implementation. 19 Along with the guidance of the JBI Evidence Implementation Framework, the project team uncovered key issues contributing to noncompliance and utilized this information to create a stakeholder-centric intervention. 16 Some key strategies included the coordination of round times via morning WhatsApp messages and the eventual stipulated medical round timing.…”

Section: Discussionmentioning

confidence: 99%

“…The project team's facilitative role was crucial in this regard. They leveraged their knowledge of the implementation context's information needs, engagement style, and work structure – nuances that are important for successful evidence implementation 19 . Along with the guidance of the JBI Evidence Implementation Framework, the project team uncovered key issues contributing to non-compliance and utilized this information to create a stakeholder-centric intervention 16 .…”

Section: Discussionmentioning

confidence: 99%

Structured, nurse-led ward rounds to improve interprofessional communication and optimize care of vascular surgery patients: a best practice implementation project

Neo,

Li,

Salazar

et al. 2023

Introduction: Ward rounds are crucial inpatient activities during which patients’ conditions are discussed. Team-based models such as nurse-led ward rounds (NLWRs) have been conceptualized and trialled, with positive results. Methods: An evidence-based quality improvement pilot project to introduce NLWRs was implemented at a cardiovascular medical-surgical unit in a Singapore tertiary hospital. The JBI Evidence Implementation Framework was used to guide the project. The evidence-based NLWR format incorporated stakeholder feedback on NLWR frequency, preparation, coordination, and content. Baseline and 6-month post-implementation audits were carried out. Results: The 4 audit criteria improved from baseline, reaching 100% compliance for criteria 1, 2, and 3 associated with interprofessional communication and collaboration. An improvement from baseline (30% to 46.7%) was also observed for criterion 4 on patient involvement during medical ward rounds. Moreover, there were improvements in clinical outcome data such as patient hospitalization length, “best medical therapy” rates, and inpatient complications. A statistically significant improvement in nurses’ confidence to lead discussions during medical rounds was also observed (p = 0.026). Conclusions: This project promoted greater compliance with NLWR criteria through audit and feedback cycles and the contextualization of implementation strategies. A well-supported program that prepares nurses for interprofessional communication also improves nurses’ confidence in team communication, bolstering their ability to provide high-quality patient care.

“…A lthough rigorous evaluation of facilitation in a complex health care system has yet to be conducted, there is recognition in the field of evidence-based practice that facilitation is a key element of successful evidence implementation (EI) or quality improvement (QI) in health care. [1][2][3] Facilitation has been described as both an individual role and a multifaceted process that enables individuals or teams to incorporate evidence into clinical practice and make changes to health care processes and outcomes. 4 This has been described by Dogherty et al (2010) as activities related to planning for change, leading and managing change, monitoring progress and ongoing implementation, and evaluating change.…”

Section: Introductionmentioning

confidence: 99%

Facilitation in evidence implementation – experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review

Lizarondo,

McArthur,

Porche

et al. 2023

Self Cite

Introduction: Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and factors that can influence its perceived effectiveness. Methods: A systematic review of qualitative studies was conducted following the JBI methodology. Results: A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators’ access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators. Conclusion: To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the “implementers” who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior. Review registration number: PROSPERO CRD42023402496