PURPOSE: Practice facilitation is an evidence-informed implementation strategy to support quality improvement (QI) and aid practices in aligning with best evidence. Few studies, particularly of this size and scope, identify strategies that contribute to facilitator effectiveness. METHODS: We conducted a sequential mixed methods study, analyzing data from EvidenceNOW, a large-scale QI initiative. Seven regional cooperatives employed 162 facilitators to work with 1,630 small or medium-sized primary care practices. Main analyses were based on facilitators who worked with at least 4 practices. Facilitators were defined as more effective if at least 75% of their practices improved on at least 1 outcome measure-aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity, measured using Change Process Capability Questionnaire-from baseline to follow-up. Facilitators were defined as less effective if less than 50% of their practices improved on these outcomes. Using an immersion crystallization and comparative approach, we analyzed observational and interview data to identify strategies associated with more effective facilitators. RESULTS: Practices working with more effective facilitators had a 3.6% greater change in the mean percentage of patients meeting the composite ABS measure compared with practices working with less effective facilitators (P <.001). More effective facilitators cultivated motivation by tailoring QI work and addressing resistance, guided practices to think critically, and provided accountability to support change, using these strategies in combination. They were able to describe their work in detail. In contrast, less effective facilitators seldom used these strategies and described their work in general terms. Facilitator background, experience, and work on documentation did not differentiate between more and less effective facilitators. CONCLUSIONS: Facilitation strategies that differentiate more and less effective facilitators have implications for enhancing facilitator development and training, and can assist all facilitators to more effectively support practice changes.
PURPOSE: Practice facilitation is an evidence-informed implementation strategy to support quality improvement (QI) and aid practices in aligning with best evidence. Few studies, particularly of this size and scope, identify strategies that contribute to facilitator effectiveness. METHODS: We conducted a sequential mixed methods study, analyzing data from EvidenceNOW, a large-scale QI initiative. Seven regional cooperatives employed 162 facilitators to work with 1,630 small or medium-sized primary care practices. Main analyses were based on facilitators who worked with at least 4 practices. Facilitators were defined as more effective if at least 75% of their practices improved on at least 1 outcome measure-aspirin use, blood pressure control, smoking cessation counseling (ABS), or practice change capacity, measured using Change Process Capability Questionnaire-from baseline to follow-up. Facilitators were defined as less effective if less than 50% of their practices improved on these outcomes. Using an immersion crystallization and comparative approach, we analyzed observational and interview data to identify strategies associated with more effective facilitators. RESULTS: Practices working with more effective facilitators had a 3.6% greater change in the mean percentage of patients meeting the composite ABS measure compared with practices working with less effective facilitators (P <.001). More effective facilitators cultivated motivation by tailoring QI work and addressing resistance, guided practices to think critically, and provided accountability to support change, using these strategies in combination. They were able to describe their work in detail. In contrast, less effective facilitators seldom used these strategies and described their work in general terms. Facilitator background, experience, and work on documentation did not differentiate between more and less effective facilitators. CONCLUSIONS: Facilitation strategies that differentiate more and less effective facilitators have implications for enhancing facilitator development and training, and can assist all facilitators to more effectively support practice changes.
Authors: Paul A Nutting; Benjamin F Crabtree; William L Miller; Elizabeth E Stewart; Kurt C Stange; Carlos Roberto Jaén Journal: Ann Fam Med Date: 2010 Impact factor: 5.166
Authors: Sarah S Ono; Benjamin F Crabtree; Jennifer R Hemler; Bijal A Balasubramanian; Samuel T Edwards; Larry A Green; Arthur Kaufman; Leif I Solberg; William L Miller; Tanisha Tate Woodson; Shannon M Sweeney; Deborah J Cohen Journal: Health Aff (Millwood) Date: 2018-02 Impact factor: 6.301
Authors: Deborah J Cohen; Bijal A Balasubramanian; Leah Gordon; Miguel Marino; Sarah Ono; Leif I Solberg; Benjamin F Crabtree; Kurt C Stange; Melinda Davis; William L Miller; Laura J Damschroder; K John McConnell; John Creswell Journal: Implement Sci Date: 2016-06-29 Impact factor: 7.327
Authors: Cynthia K Perry; Laura J Damschroder; Jennifer R Hemler; Tanisha T Woodson; Sarah S Ono; Deborah J Cohen Journal: Implement Sci Date: 2019-03-21 Impact factor: 7.327
Authors: Grant Russell; Riki Lane; Sharon Parker; John Litt; Danielle Mazza; Jane Lloyd; Nicholas Zwar; Mieke van Driel; Chris Del Mar; Jane Smith; Mark F Harris Journal: BMC Fam Pract Date: 2019-08-08 Impact factor: 2.497
Authors: Theresa L Walunas; Jiancheng Ye; Jennifer Bannon; Ann Wang; Abel N Kho; Justin D Smith; Nicholas Soulakis Journal: Implement Sci Date: 2021-03-31 Impact factor: 7.327