External Facilitation as an Evidence‐Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units

Abstract

Background: Despite research support, evidence-based practices (EBPs) are inconsistently implemented throughout the United States. Facilitation is one implementation strategy to speed adoption in clinical settings. Facilitation has not been previously described in the literature as an implementation strategy within neonatal care.Purpose: The purpose of this study was to categorize and describe essential features of facilitation in the context of implementing an EBP using perspectives elicited from neonatal clinicians and external facilitators (EFs).Methods: In this qualitative descriptive study, semistructured interviews were conducted with a purposive sample of neonatal clinicians and EFs. Participants shared their experiences related to the strategy of facilitation while implementing an EBP during the California Perinatal Quality Care Antibiotic Stewardship Collaborative. Interviews were transcribed, coded, and analyzed using directed content analysis.Results: Five categories emerged to address facilitation as an implementation strategy: (a) facilitated change management, (b) unit and organization receptivity, (c) evaluation strategies, (d) supportive culture, and (e) facilitator stewardship.Linking Evidence to Action: Implementing EBP is complex and multifactorial. Results from this study provide insights into influencing barriers and drivers as experienced by internal and external facilitators, and context factors that impacted the success of implementation.

Feasibility and Acceptability of a Neonatal Project ECHO (NeoECHO) as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis

“…In the i-PARHIS framework, it is essential to consider all implementation components beyond just the evidence (i.e., unit context and resources needed to implement; Harvey & Kitson, 2016). Our findings are consistent with facilitation studies in adult and neonatal care contexts that showed context and resources were also important to success (Harvey, McCormack, Kitson, Lynch, & Titchen, 2018;Quinn, Gephart, & Davis, 2019). NICU resources varied regarding time for QI, availability of NICU-specific lactation support and nursing education, donor human milk, and donor-based human milk fortifiers.…”

“…Casebased learning allowed real, de-identified NEC cases to be discussed, which ultimately spurred discussion and sharing of strategies to prevent NEC. All units were retained through the series, which was rare when compared to other neonatal collaboratives that used a facilitation model (Quinn et al, 2019). One potential reason for our retention of units could be due to the external facilitation provided by the hub and inclusion of IFs as core team members.…”

“…One potential reason for our retention of units could be due to the external facilitation provided by the hub and inclusion of IFs as core team members. This differed from the California Perinatal Quality Collaborative facilitation project, where the external facilitators were primarily volunteer physicians with decentralized activities (Quinn et al, 2019).…”

Evidence-based practice by physiotherapists in UAE: Investigating behavior, attitudes, awareness, knowledge and barriers

“…Other barriers include a lacking organizational culture which encourages and promotes the use of EBP. Quinn et al [28] reported that facilitator stewardship, evaluation strategies, supportive culture, organization receptivity, and facilitated change management are needed for the appropriate implementation of EBP. A lack of awareness of EBP is one of the foremost barriers to applying it.…”

Does coaching matter? Examining the impact of specific practice facilitation strategies on implementation of quality improvement interventions in the Healthy Hearts in the Heartland study

“…Recent studies demonstrate that practice facilitation increases the likelihood of success of QI initiatives, increases provider adherence to evidence-based guidelines, and improves care quality metrics in a broad array of clinical settings [8][9][10][11]. Practice facilitation has been used to effectively support implementation of evidence-based behavioral health interventions [12,13], integrated behavioral health and primary care [14], colorectal screening [15], antibiotic stewardship [16], pediatric preventive care [11], and implementation of patient-centered medical home programs [17][18][19].…”