External facilitators' perceptions of internal facilitation skills during implementation of collaborative care for mental health teams: a qualitative analysis informed by the i-PARIHS framework

Samantha L Connolly, Jennifer L Sullivan, Mona J Ritchie, Bo Kim, Christopher J Miller, Mark S Bauer, Samantha L Connolly, Jennifer L Sullivan, Mona J Ritchie, Bo Kim, Christopher J Miller, Mark S Bauer

Abstract

Background: Facilitation is a key strategy that may contribute to successful implementation of healthcare innovations. In blended facilitation, external facilitators (EFs) guide and support internal facilitators (IFs) in directing implementation processes. Developers of the i-PARIHS framework propose that successful facilitation requires project management, team/process, and influencing/negotiating skills. It is unclear what IF skills are most important in real-world settings, which could inform recruitment and training efforts. As prior qualitative studies of IF skills have only interviewed IFs, the perspectives of their EF partners are needed. Furthermore, little is known regarding the distribution of implementation tasks between IFs and EFs, which could impact sustainability once external support is removed. In the context of an implementation trial, we therefore: 1) evaluated IFs' use of i-PARIHS facilitation skills, from EFs' perspectives; 2) identified attributes of IFs not encompassed within the i-PARIHS skills; and 3) investigated the relative contributions of IFs and EFs during facilitation.

Methods: Analyses were conducted within a hybrid type II trial utilizing blended facilitation to implement the collaborative chronic care model within mental health teams of nine VA medical centers. Each site committed one team and an IF to weekly process design meetings and additional implementation activities over 12 months. Three EFs worked with three sites each. Following study completion, the EFs completed semi-structured qualitative interviews reflecting on the facilitation process, informed by the i-PARIHS facilitation skill areas. Interviews were analyzed via directed content analysis.

Results: EFs emphasized the importance of IFs having strong project management, team/process, and influencing/negotiating skills. Prior experience in these areas and a mental health background were also benefits. Personal characteristics (e.g., flexible, assertive) were described as critical, particularly when faced with conflict. EFs discussed the importance of clear delineation of EF/IF roles, and the need to shift facilitation responsibilities to IFs.

Conclusions: Key IF skills, according to EFs, are aligned with i-PARIHS recommendations, but IFs' personal characteristics were also emphasized as important factors. Findings highlight traits to consider when selecting IFs and potential training areas (e.g., conflict management). EFs and IFs must determine an appropriate distribution of facilitation tasks to ensure long-term sustainability of practices.

Trial registration: Clinicaltrials.gov, September 7, 2015, #NCT02543840.

Keywords: Blended facilitation; External facilitators; Internal facilitators; i-PARIHS framework.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Butow P, Shaw J, Shepherd HL, Price M, Masya L, Kelly B, et al. Comparison of implementation strategies to influence adherence to the clinical pathway for screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP): study protocol of a cluster randomised controlled trial. BMC Cancer. 2018;18(1):1077. doi: 10.1186/s12885-018-4962-9.
    1. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8(1):139. doi: 10.1186/1748-5908-8-139.
    1. Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, et al. Getting evidence into practice: the role and function of facilitation. J Adv Nurs. 2002;37(6):577–588. doi: 10.1046/j.1365-2648.2002.02126.x.
    1. Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci. 2015;11(1):33. doi: 10.1186/s13012-016-0398-2.
    1. Kirchner JE, Ritchie MJ, Pitcock JA, Parker LE, Curran GM, Fortney JC. Outcomes of a partnered facilitation strategy to implement primary care–mental health. J Gen Intern Med. 2014;29(4):904–912. doi: 10.1007/s11606-014-3027-2.
    1. Ritchie M, Kirchner J. Facilitation: a key strategy in the field of implementation science. FORUM: VA Office of Research & Development, Health Services Research & Development Service, Center for Information Dissemination and Education Resources. 2017.
    1. Ritchie MJ, Parker LE, Edlund CN, Kirchner JE. Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: a qualitative study. BMC Health Serv Res. 2017;17(1):294. doi: 10.1186/s12913-017-2217-0.
    1. Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, et al. Role of “external facilitation” in implementation of research findings: a qualitative evaluation of facilitation experiences in the veterans health administration. Implement Sci. 2006;1(1):23. doi: 10.1186/1748-5908-1-23.
    1. Dogherty EJ, Harrison MB, Baker C, Graham ID. Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation. Implement Sci. 2012;7(1):9. doi: 10.1186/1748-5908-7-9.
    1. Dogherty EJ, Harrison MB, Graham ID, Vandyk AD, Keeping-Burke L. Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice. Worldviews Evid-Based Nurs. 2013;10(3):129–139. doi: 10.1111/wvn.12009.
    1. Kotecha J, Han H, Green M, Russell G, Martin MI, Birtwhistle R. The role of the practice facilitators in Ontario primary healthcare quality improvement. BMC Fam Pract. 2015;16(1):93. doi: 10.1186/s12875-015-0298-6.
    1. Loftus-Hill A, Harvey G. A review of the role of facilitators in changing professional health care practice. RCN Institute. 2000.
    1. Dogherty EJ, Harrison MB, Graham ID. Facilitation as a role and process in achieving evidence-based practice in nursing: a focused review of concept and meaning. Worldviews Evid-Based Nurs. 2010;7(2):76–89.
    1. Ritchie MJ. Transferring implementation facilitation knowledge and skills to improve healthcare delivery systems (dissertation) Fayetteville: University of Arkansas; 2016.
    1. Elledge C, Avworo A, Cochetti J, Carvalho C, Grota PJC. Characteristics of facilitators in knowledge translation: an integrative review. Collegian. 2018;26(1):171–182. doi: 10.1016/j.colegn.2018.03.002.
    1. Bauer MS, Miller C, Kim B, Lew R, Weaver K, Coldwell C, et al. Partnering with health system operations leadership to develop a controlled implementation trial. Implement Sci. 2015;11(1):22. doi: 10.1186/s13012-016-0385-7.
    1. Bauer MS, Miller CJ, Kim B, Lew R, Stolzmann K, Sullivan J, et al. Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(3):e190230. doi: 10.1001/jamanetworkopen.2019.0230.
    1. Miller CJ, Grogan-Kaylor A, Perron BE, Kilbourne AM, Woltmann E, Bauer MS. Collaborative chronic care models for mental health conditions: cumulative meta-analysis and metaregression to guide future research and implementation. Med Care. 2013;51(10):922–930. doi: 10.1097/MLR.0b013e3182a3e4c4.
    1. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127(12):1097–1102. doi: 10.7326/0003-4819-127-12-199712150-00008.
    1. Kirchner J. Behavioral health QUERI implementation facilitation training hub VA Quality Enhancement Research Initiative. 2019.
    1. Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall RJ. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007;2(1):42. doi: 10.1186/1748-5908-2-42.
    1. NVivo 10 . QSR International. 2012.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288. doi: 10.1177/1049732305276687.
    1. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–1251. doi: 10.1097/ACM.0000000000000388.
    1. Ritchie M, Dollar K, Miller C, Oliver K, Smith J, Lindsay J, et al. Using implementation facilitation to improve Care in the Veterans Health Administration (version 2) 2017.
    1. Braun V, Clarke V, Terry G. Thematic analysis. APA handbook of research methods in psychology. 2012. pp. 57–71.

Source: PubMed

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