Research and Services Partnerships: Responding to Needs of Clinical Operations Partners: Transferring Implementation Facilitation Knowledge and Skills

Ritchie, Mona J.; Dollar, Katherine M.; Kearney, Lisa K.; Kirchner, JoAnn E.

doi:10.1176/appi.ps.201300468

Cited by 41 publications

(35 citation statements)

References 8 publications

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“…In fact, VA leadership has already adopted this facilitation strategy to support implementation of PC-MHI, as well as other policy-mandated evidence-based innovations, at facilities across VA that struggle to implement new programs [9, 10, 15, 75]. Based on experiences of facilitators in this study, we developed IF training materials and the external expert facilitator (JEK) and one of the internal regional facilitators have been training clinical operations personnel in these methods [76, 77]. They have also trained other researchers in the application of implementation facilitation.…”

Section: Discussionmentioning

confidence: 99%

Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study

Ritchie

Parker

Edlund

et al. 2017

BMC Health Serv Res

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BackgroundWe evaluated a facilitation strategy to help clinical sites likely to experience challenges implement evidence-based Primary Care-Mental Health Integration (PC-MHI) care models within the context of a Department of Veterans Affairs (VA) initiative. This article describes our assessment of whether implementation facilitation (IF) can foster development of high quality PC-MHI programs that adhere to evidence, are sustainable and likely to improve clinical practices and outcomes.MethodsUtilizing a matched pair design, we conducted a qualitative descriptive evaluation of the IF strategy in sixteen VA primary care clinics. To assess program quality and adherence to evidence, we conducted one-hour structured telephone interviews, at two time points, with clinicians and leaders who knew the most about the clinics’ programs. We then created structured summaries of the interviews that VA national PC-MHI experts utilized to rate the programs on four dimensions (overall quality, adherence to evidence, sustainability and level of improvement).ResultsAt first assessment, seven of eight IF sites and four of eight comparison sites had implemented a PC-MHI program. Our qualitative assessment suggested that experts rated IF sites’ programs higher than comparison sites’ programs with one exception. At final assessment, all eight IF but only five comparison sites had implemented a PC-MHI program. Again, experts rated IF sites’ programs higher than their matched comparison sites with one exception. Over time, all ratings improved in five of seven IF sites and two of three comparison sites.ConclusionsImplementing complex evidence-based programs, particularly in settings that lack infrastructure, resources and support for such efforts, is challenging. Findings suggest that a blend of external expert and internal regional facilitation strategies that implementation scientists have developed and tested can improve PC-MHI program uptake, quality and adherence to evidence in primary care clinics with these challenges. However, not all sites showed these improvements. To be successful, facilitators likely need at least a moderate level of leaders’ support, including provision of basic resources. Additionally, we found that IF and strength of leadership structure may have a synergistic effect on ability to implement higher quality and evidence-based programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2217-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study

Ritchie

Parker

Edlund

et al. 2017

BMC Health Serv Res

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“…VA leadership has already adopted IF nationally and has expanded it beyond PC-MHI to other clinical initiatives, with our facilitators training clinical operations personnel and developing resources. 24,34,35 Although this work was conducted within VA, the IF strategy could be applied in other healthcare systems willing to provide resources dedicated to innovative implementation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health

et al. 2014

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“…This manuscript describes the development, implementation, and evaluation of a highly partnered IF Training Program that addresses this gap. The IF Training Program, which was initiated to address healthcare leaders' needs within a single large healthcare system (VHA) [34], has developed into a robust program that continues to train growing numbers of implementation practitioners and researchers inside and outside of the healthcare system for which it was originally developed.…”

Section: Discussionmentioning

confidence: 99%

“…In response to this request, we began collaborative discussions with them about ways to meet their needs, resources they could contribute to the effort, and future partnership activities. Literature and our own experiences suggested that our partners needed information on IF that was relevant, timely, and written in nonacademic language [34,35]. Subsequently, we developed an IF Training Manual to serve as source material for a training workshop on IF and as a reference for those receiving ongoing mentoring in IF [36].…”

Section: Initial Development Of the Implementation Facilitation Trainmentioning

confidence: 99%

The Next Challenge in Implementation Science: Transferring Implementation Strategy Knowledge and Skills

Kirchner¹,

Dollar²,

Smith³

et al. 2020

Preprint

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Background: Complex evidence-based clinical innovations are challenging to implement, with many settings requiring implementation assistance to increase likelihood of innovation uptake with fidelity. Implementation science researchers are identifying evidence-based implementation strategies that support the uptake of evidence-based practices and other clinical innovations. However, there is limited information regarding how to develop methods to educate implementation practitioners on the use of implementation strategies and how to sustain these competencies over time. We developed, initiated, and evaluated an implementation training program for both implementation researchers and practitioners.Methods: Participants who attended 7 trainings were asked to complete an electronic survey 2 weeks before training, immediately post-training, and 6 months post-training. We assessed participant knowledge and confidence in applying implementation facilitation skills using a 4-point Likert scale. Scores were compared at baseline to those provided post-training and at 6 months, as well as post-training to 6 months post-training (using nonparametric Wilcoxon Signed Rank tests).Results: One hundred and two participants (76 in-person, 26 virtually) completed the pre-and post-training evaluation. Participants reported a significant increase in perceived knowledge and confidence across all implementation facilitation domains from pre- to post-training and pre- to 6-month training follow up. There was no significant difference between virtual and in-person participants. When comparing post-training to 6-months, increases in perceptions of knowledge remained unchanged though half of the domains showed significantly lower perceived confidence to apply facilitation skills. Conclusions: Our findings indicate that we have developed and conducted an effective Implementation Facilitation Program with participants reporting significant increased knowledge and confidence applying implementation facilitation skills. These results were sustained among trainees at 6 months post-training, as participants reported perceived improvements in knowledge and confidence in applying implementation facilitation skills in all domains. Additionally, knowledge and confidence change scores did not differ based on in-person versus virtual attendance, suggesting that implementation training can successfully be provided to a remote site without loss of knowledge/skills transfer. The decrease in perceived confidence in applying skills from post-training to 6-months post training in some areas indicate a need for ongoing support of facilitation practitioners.

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Research and Services Partnerships: Responding to Needs of Clinical Operations Partners: Transferring Implementation Facilitation Knowledge and Skills

Cited by 41 publications

References 8 publications

Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study

Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health

The Next Challenge in Implementation Science: Transferring Implementation Strategy Knowledge and Skills

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