Dedicated Workforce Required to Support Large-Scale Practice Improvement.

Area of Science:

• Implementation Science
• Healthcare Quality Improvement
• Primary Care Research

Background:

• Facilitation effectively supports evidence-based practice (EBP) implementation in healthcare settings.
• Limited research exists on the necessary infrastructure for large-scale EBP dissemination and implementation initiatives.

Purpose of the Study:

• To identify organizational elements and infrastructures used by Cooperatives to support facilitators in large-scale primary care quality improvement.
• To examine the support mechanisms for facilitators involved in disseminating cardiovascular preventive care improvements.

Main Methods:

• Review of facilitator logs, online diary data, semistructured interviews, and observational fieldnotes from 7 Cooperatives.
• Analysis of data using a coding and sorting process to identify supportive infrastructures and organizational elements.

Main Results:

• Cooperatives assembled facilitator teams (16-35 individuals) by partnering with multiple organizations.
• Quality assurance involved comprehensive training, facilitator support processes, and consistent monitoring.
• Development of facilitator toolkits, initiative-specific training, and peer-to-peer learning platforms were key strategies.

Conclusions:

• A robust infrastructure, including initial and ongoing training, support, and monitoring, is essential for a large-scale facilitation workforce.
• Fragmented quality improvement approaches may be less efficient than facilitation strategies that integrate primary care functions.