Forming and activating an internal facilitation group for successful implementation: A qualitative study.

Area of Science:

• Implementation Science
• Healthcare Quality Improvement
• Pharmacy Practice

Background:

• Focuses on an implementation facilitation strategy to enhance anticoagulation care delivery in Veterans Health Administration (VA) pharmacy clinics.
• Explores the role of an internal facilitation team of anticoagulation coordinators in improving evidence-based practice change.
• Compares internal facilitation (IF) with external facilitation (EF) and blended facilitation (BF) models.

Purpose of the Study:

• To examine how an internal facilitation team became instrumental in the successful implementation of evidence-based practice change in anticoagulation care.
• To identify factors that enhance the uptake of an anticoagulation initiative within pharmacy-run clinics.
• To understand the development and effectiveness of internal facilitation teams in healthcare settings.

Main Methods:

• Conducted semi-structured interviews annually over 4 years with representatives and internal facilitators (site champions) at 8 VA hospitals (47 interviews).
• Interviewed five external facilitators who guided the implementation process.
• Utilized a deductive approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model and emergent thematic analysis.

Main Results:

• Regular participation by site champions in the internal facilitation team enhanced initiative uptake.
• Strong commitment from champions to act as agents of change was crucial for success.
• Increased supervisor support for champions facilitated practice changes and stronger team engagement.

Conclusions:

• Internal facilitators learn and develop skills over time, with group support enhancing success.
• Findings guide the incorporation of internal facilitation teams as a viable implementation strategy.
• Demonstrates how healthcare sites can build capacity for sustained implementation efforts.