Role enactment of facilitation in primary care – a qualitative study

Abstract

BackgroundFacilitation is a widely used implementation method in quality improvement. Reviews reveal a variety of understandings of facilitation and facilitator roles. Research suggests that facilitation interventions should be flexible and tailored to the needs and circumstances of the receiving organisations. The complexity of the facilitation field and diversity of potential facilitator roles fosters a need to investigate in detail how facilitation is enacted. Hence, the purpose of this study was to explore the enactment of external peer facilitation in general practice in order to create a stronger basis for discussing and refining facilitation as an implementation method.MethodsThe facilitation intervention under study was conducted in general practice in the Capital Region of Denmark in order to support an overall strategy for implementing chronic disease management programmes. We observed 30 facilitation visits in 13 practice settings and had interviews and focus groups with facilitators. We applied an explorative approach in data collection and analysis, and conducted an inductive thematic analysis.ResultsThe facilitators mainly enacted four facilitator roles: teacher, super user, peer and process manager. Thus, apart from trying to keep the process structured and focused the facilitators were engaged in didactic presentations and hands-on learning as they tried to pass on factual information and experienced based knowledge as well as their own enthusiasm towards implementing practice changes. While occasional challenges were observed with enacting these roles, more importantly we found that a coaching based role which was also envisioned in the intervention design was only sparsely enacted meaning that the facilitators did not enable substantial internal group discussions during their facilitation visits.ConclusionFacilitation is a complex phenomenon both conceptually and in practice. This study complements existing research by showing how facilitation can be enacted in various ways and by suggesting that some facilitator roles are more likely to be enacted than others, depending on the context and intervention design and the professional background of the facilitators. This complexity requires caution when comparing and evaluating facilitation studies and highlights a need for precision and clarity about goals, roles, and competences when designing, conducting, and reporting facilitation interventions.

From novice to expert: a qualitative study of implementation facilitation skills

“…Given the complexity of implementation facilitation, it is not surprising scholars suggest that facilitators need a diverse range of knowledge and skills that they can apply depending on the purpose and context of their efforts [ 13 , 28 – 30 ]. Lack of these skills may compromise fidelity to the planned facilitation intervention and negatively influence outcomes [ 31 – 34 ]. Thus, studies or clinical initiatives applying facilitation as an implementation strategy need to ensure that facilitators have the necessary skills or provide training for developing those skills [ 35 , 36 ].…”

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."…”

Influences of peer facilitation in general practice – a qualitative study

“…The intervention has been described in more detail elsewhere [ 13 ]. As researchers, our role was to study the intervention and we were not involved in either the design or the implementation of the intervention.…”

“…The intervention relied on general practitioners (GPs) as facilitators. In two previous studies, we explored how facilitation was enacted in this intervention and the effectiveness of the intervention [ 12 , 13 ]. First, based on observations and interviews with facilitators we found that facilitation was enacted through four major roles: the teacher (knowledge dissemination), the super user (hands-on knowledge dissemination on the practice’s computer system), the peer (facilitators conveying their experiences and information about their own practice organisation), and the process manager (selection of topics, tasks, and status reporting at subsequent visits).…”

“…First, based on observations and interviews with facilitators we found that facilitation was enacted through four major roles: the teacher (knowledge dissemination), the super user (hands-on knowledge dissemination on the practice’s computer system), the peer (facilitators conveying their experiences and information about their own practice organisation), and the process manager (selection of topics, tasks, and status reporting at subsequent visits). We also found that the facilitators rarely enacted a more coaching based approach to encourage internal reflection and discussion during the visits [ 13 ]. Second, our randomised controlled trial on the intervention’s effectiveness showed mixed results.…”