Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration

Abstract

Background: 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. Methods: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: 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. BackgroundImplementation of research findings into practice is a complex undertaking that has often fallen short of expectations. In part, this is due to the current lack of substantive knowledge regarding both individual implementation interventions and the interrelationship of multiple interventions used in m...

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“…[4][5][6][7] Implementation Facilitation (IF) has shown promise in implementing programs and practices, particularly at locations that would otherwise be unable to conduct quality improvement efforts. IF strategies that bundle evidence-based implementation interventions 8 usually also focus on building relationships and partnering with sites. [8][9][10][11] Facilitators use particular activities and techniques depending on the purpose of facilitation and stakeholder needs.…”

“…IF strategies that bundle evidence-based implementation interventions 8 usually also focus on building relationships and partnering with sites. [8][9][10][11] Facilitators use particular activities and techniques depending on the purpose of facilitation and stakeholder needs. [12][13][14][15] Unfortunately, when funding ends, sites often have difficulty sustaining changes.…”

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