From novice to expert: a qualitative study of implementation facilitation skills

Abstract

Background: It is widely reported that facilitation can aid implementation of evidence-based practices. Although scholars agree that facilitators need a diverse range of skills, only a few retrospective studies have identified some of these. During the test of a facilitation strategy within the context of a VA initiative to implement evidence-based care delivery models, we documented the skills an expert external facilitator transferred to two initially novice internal regional facilitators. Ours is the first study to explore facilitation skills as they are being applied and transferred. Methods: Facilitators applied the strategy at eight primary care clinics that lacked implementation capacity in two VA networks. We conducted monthly debriefing interviews over a 30-month period and documented these in detailed notes. External facilitator interviews focused specifically on training and mentoring internal facilitators and the skills that she transferred. We also conducted, recorded, and transcribed two qualitative interviews with each facilitator and queried them about training content and process. We conducted a content analysis of the data, using deductive and inductive methods, to identify skills the external facilitator helped internal facilitators learn. We also explored the complexity of facilitation skills and grouped them into overarching skillsets. Results: The external facilitator helped internal facilitators learn 22 complex skills; with few exceptions, these skills were not unique but overlapped with one another. We clustered 21 of these into 5 groups of overarching skillsets: (1) building relationships and creating a supportive environment, (2) changing the system of care and the structure and processes that support it, (3) transferring knowledge and skills and creating infrastructure support for ongoing learning, (4) planning and leading change efforts, and (5) assessing people, processes, and outcomes and creating infrastructure for program monitoring. Conclusions: This study documented a broad range of implementation facilitation skills that are complex and overlapping. Findings suggest that studies and initiatives planning or applying facilitation as an implementation strategy should ensure that facilitators have or have the opportunity to learn the skills they need. Because facilitation skills are complex, the use of didactic methods alone may not be sufficient for transferring skills; future work should explore other methods and techniques.

Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow‐implementer community practices

“…Facilitation has been an effective and oft‐used implementation strategy, especially for CCMs. While specific mechanisms of facilitation effectiveness are still largely unknown, 26,59 facilitation is thought to be effective because facilitators have a diverse array of skills that allow for flexibility in accommodating site needs as they change over time and encouraging organizational learning 30,59,60 . With few notable exceptions, 61‐63 few studies have compared the effectiveness of different forms of facilitation, or examined whether this comparative effectiveness is moderated by organizational characteristics or earlier implementation progress.…”

“…While specific mechanisms of facilitation effectiveness are still largely unknown, 26,59 facilitation is thought to be effective because facilitators have a diverse array of skills that allow for flexibility in accommodating site needs as they change over time and encouraging organizational learning. 30,59,60 With few notable exceptions, [61][62][63] few studies have compared the effectiveness of different forms of facilitation, or examined whether this comparative effectiveness is moderated by organizational characteristics or earlier implementation progress. Our results, however, suggested that sites that were further along in the implementation process benefitted differently-and, in fact, less-from more intensive EF/IF than sites that were further behind.…”

From novice to expert: methods for transferring implementation facilitation skills to improve healthcare delivery

“…To explore patterns in the data, MJR created Excel spreadsheet data displays for each skill [ 19 ] that the expert transferred, documenting, for each instance, the expert’s technique(s); date; trainee; site(s); primary target of the expert’s efforts (e.g., trainee, site leader, meeting attendees); and an abbreviated summary of what the expert was helping trainees learn. Using these data displays, she explored patterns in how facilitators were interacting with each other and with site stakeholders, as well as changes in the level of intensity with which interactions occurred over time.…”

“…The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework posits that facilitation is the active ingredient in the implementation process; facilitators need to assess and respond to the characteristics of the innovation being implemented, the individuals and teams involved in or affected by innovation implementation, and the organizational context [ 1 , 18 ]. Thus, facilitators need a wide range of very complex skills [ 19 ]. Lack of these skills can compromise fidelity to the facilitation intervention and ultimately has a negative effect on outcomes [ 20 – 23 ].…”

“…By design, in addition to supporting implementation, the expert external facilitator transferred facilitation skills to healthcare system change agents, who were initially novices but became expert facilitators by the end of the project. A previous study documented the complex skills the expert transferred [ 19 ]; this study, also a component of the larger project and the first author’s doctoral dissertation [ 54 ], explored how the expert transferred these skills to support implementation of PCMHI, as well as build capacity for future implementation efforts. For this paper, we call the internal facilitators, facilitation trainees.…”