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Related Experiment Video

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Effective Facilitator Strategies for Supporting Primary Care Practice Change: A Mixed Methods Study.

Shannon M Sweeney1, Andrea Baron2, Jennifer D Hall2

  • 1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon sweenesh@ohsu.edu.

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|October 13, 2022
PubMed
Summary

Effective practice facilitation significantly improves healthcare quality improvement outcomes. More effective facilitators tailor strategies, address resistance, and provide accountability, leading to better practice changes.

Keywords:
capacity buildingimplementation facilitationlarge-scale initiativeorganizational changeorganizational innovationpractice facilitationquality improvement

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Area of Science:

  • Implementation Science
  • Healthcare Quality Improvement
  • Primary Care Research

Background:

  • Practice facilitation is a key strategy for implementing evidence-based practices in healthcare.
  • Identifying factors that enhance facilitator effectiveness is crucial for successful quality improvement initiatives.
  • Large-scale studies are needed to understand the nuances of effective facilitation.

Purpose of the Study:

  • To identify specific strategies employed by more effective practice facilitators in a large-scale quality improvement initiative.
  • To differentiate the approaches of effective versus less effective facilitators in primary care settings.
  • To inform the development of training programs for practice facilitators.

Main Methods:

  • A sequential mixed methods study analyzed data from the EvidenceNOW initiative, involving 162 facilitators and 1,630 primary care practices.
  • Facilitator effectiveness was defined based on the percentage of practices achieving improvements in aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity.
  • Observational and interview data were analyzed using an immersion crystallization and comparative approach.

Main Results:

  • Practices with more effective facilitators showed a 3.6% greater improvement in the composite ABS measure compared to those with less effective facilitators (P <.001).
  • More effective facilitators tailored QI work, addressed resistance, fostered critical thinking, and provided accountability.
  • Effective facilitators described their work in detail, unlike less effective facilitators who used general terms.

Conclusions:

  • Specific facilitation strategies, including tailoring, addressing resistance, critical thinking guidance, and accountability, distinguish effective facilitators.
  • These findings have direct implications for improving facilitator training and development.
  • Enhancing these strategies can optimize the support provided to practices for implementing changes.