Virtual external implementation facilitation: successful methods for remotely engaging groups in quality improvement

Abstract

Background Relatively little guidance exists on how to use virtual implementation facilitation to successfully implement evidence-based practices and innovations into clinical programs. Yet virtual methods are increasingly common. They have potentially wider reach, emergent public health situations necessitate their use, and restrictions on resources can make them more attractive. We therefore outline a set of principles for virtual external implementation facilitation and a series of recommendations based on extensive experience successfully using virtual external implementation facilitation in a national program. Model and recommendations Success in virtual external implementation facilitation may be achieved by facilitators applying three overarching principles: pilot everything, incorporate a model, and prioritize metacognition. Five practical principles also help: plan in advance, communicate in real time, build relationships, engage participants, and construct a virtual room for participants. We present eight concrete suggestions for enacting the practical principles: (1) assign key facilitation roles to facilitation team members to ensure the program runs smoothly; (2) create small cohorts of participants so they can have meaningful interactions; (3) provide clarity and structure for all participant interactions; (4) structure program content to ensure key points are described, reinforced, and practiced; (5) use visuals to supplement audio content; (6) build activities into the agenda that enable participants to immediately apply knowledge at their own sites, separate from the virtual experience; (7) create backup plans whenever possible; and (8) engage all participants in the program. Summary These principles represent a novel conceptualization of virtual external implementation facilitation, giving structure to a process that has been, to date, inadequately described. The associated actions are demonstrably useful in supporting the principles and offer teams interested in virtual external implementation facilitation concrete methods by which to ensure success. Our examples stem from experiences in healthcare. But the principles can, in theory, be applied to virtual external implementation facilitation regardless of setting, as they and the associated actions are not setting specific.

Feasibility of Group-Based Implementation Facilitation for Video Telemental Health

“…Recent work on IF in the context of virtual facilitation identified several key practice elements, including planning in advance, real-time communication, build relationships, engaging participants, and using a virtual room (Hartmann et al, 2021 ). The current group facilitation used several elements of this framework, including communication and engaging participants.…”

“…These skills include collaborative problem solving, engaging with leadership, building awareness of the intervention, and other skills (Ritchie et al, 2020 ). IF has been successfully used to implement evidence-based practices virtually and in group/organization settings (Hartmann et al, 2021 ). IF has been used successfully to implement VVC in healthcare settings, including those in less-resourced rural areas (Day et al, 2021 ).…”

“…The context of top-down directives to increase use of VVC necessitated a more rapid approach with greater reach that simultaneously met the minimum threshold for providing VVC (e.g., technology training) and facilitated sustainable use of VVC in clinicians’ contexts. In light of these needs, our group built on extant IF principles (Hartmann et al, 2021 ; Ritchie et al, 2020 ) to provide facilitation in small groups formed by stakeholders from clinic units.…”

Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric oncology centers in Latin America

“…As the ongoing pandemic continues to restrict international travel, lessons learned from our experience can benefit future programs that use virtual facilitation. Future work is needed to establish best practices for virtual engagement in implementation science 58 and to explore the pandemic’s impact on ongoing quality‐improvement initiatives like PEWS.…”

Implementation and outcome evaluations of a multi‐site improvement program in cancer genetics

“…Program activities included VIF which is “a process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship,” and is “conducted with limited or no in‐person contact between the facilitator and the site implementing the innovation” (Ritchie et al, 2017; Stetler et al, 2006). VIF core competencies have been previously described and include, for example; relationship building, creating a supportive environment for change, assessing people, processes, and outcomes; transferring knowledge and skills; and creating infrastructure support for ongoing learning and program monitoring (Hartmann et al, 2021; Ritchie et al, 2017; Stetler et al, 2006). VIF can also include implementation tasks such as identifying and engaging stakeholders, providing technical support, training, evaluation, and other activities (Powell et al, 2015; Ritchie et al, 2017; Stetler et al, 2006).…”