Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

Abstract

Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.

Evaluating community participation: A comparison of participatory approaches in the planning and implementation of new primary health‐care services in northern Australia

“…Furthermore, relational factors such as building trust, developing relationships, and awareness of the wider context were significant elements that the facilitation team brought to the service plans. Stetler et al emphasized the potential of the facilitator in successful implementation of new ways of working, stating that “facilitators need to be flexible and possess a range of skills to be used according to the needs of those with whom they are working and the related context.” It is also important to be mindful that the role of facilitator is not to influence, direct, or coerce . Based on our findings from the present study, we would suggest further work to explore the role of external facilitation influencing community participation.…”

Exploring the Attributes of Exemplary Facilitators in Family Medicine Residencies: Implications for Practice Transformation

“…doi: 10.22454/FamMed.2019.774561 are limited. 2,3,6,7,11,19,20 Much research focuses on external practice facilitators who, coming into an organization from the outside, may need different skills to work with an unfamiliar group. 1,21 The goal of this project was to explore attributes of internal staff identified by family medicine residency directors as "people in the office or clinic who make things easier."…”

“…ORIGINAL ARTICLES I n health care literature, the term "practice facilitator" describes someone who assists clinicians in practice transformation projects. [1][2][3][4][5][6][7][8] These facilitators commonly work toward improving the delivery of clinical interventions, particularly preventive services [9][10] ; facilitating research and quality improvement (QI) projects [11][12] ; and implementing health information technology.…”

“…13 This concept of facilitation, grounded in the 1980's literature on nursing evidence-based practice, includes a varying set of characteristics and qualifications held by people who make things easier. 4,7,9,[14][15][16] Specifically, researchers have described facilitators as being empathic, sensitive, flexible, resilient, authentic, and passionate about their work. 3,14 They have been called "agents of change" and "crosspollinators of good ideas."…”

“…15 Not typically in formal leadership roles, they are thought to be information-givers, trainers, researchers, and advisors who possess project management and interpersonal communication skills to move ideas forward to fruition. 3,7,11 Capturing both the personal attributes and the professional competencies involved in facilitation, Harvey et al 16 in 2002 described the concept of facilitation on a continuum. The task end of the continuum is characterized by practical, taskdriven activities such as administering and supporting QI projects.…”