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Perry CK, Lindner S, Hall J, Solberg LI, Baron A, Cohen DJ. How Type of Practice Ownership Affects Participation with Quality Improvement External Facilitation: Findings from EvidenceNOW. J Gen Intern Med 2022; 37:793-801. [PMID: 34981342 PMCID: PMC8904707 DOI: 10.1007/s11606-021-07204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Facilitation is an implementation strategy that can help primary care practices improve healthcare quality and build quality improvement (QI) capacity when delivered in a flexible manner by trained professionals. Practice ownership is associated with use of QI. However, little is known about how practices of different ownership participate in external facilitation, and this could inform future initiatives. OBJECTIVE Using data from EvidenceNOW, we examined how practice ownership influences participation in external facilitation. STUDY DESIGN We used an iterative mixed-methods design. PARTICIPANTS, APPROACH, AND MEASURES We collected data from practices on practice characteristics (e.g., location, size, payer mix) and ownership type via surveys and from facilitators on the number of hours, encounters, and months each practice had with a facilitator via facilitation logs. Using multivariable linear regression, we examined the association between facilitation and ownership (n = 1117 practices). We conducted semi-structured interviews with EvidenceNOW leadership (n = 12) and facilitators (n = 51) and observed facilitators in a subset of practices (n = 64); we analyzed this qualitative data for patterns of facilitation. KEY RESULTS In the fully adjusted model, differences by ownership were non-significant; FQHCs, however, had significantly less participation in facilitation than clinician-owned practices across two measures (unadjusted difference: - 2.83, p < 0.01 for number of encounters, and - 2.04, p < 0.01 for number of months with encounters). Qualitative data showed that Health System and FQHC ownership influenced types of practices enrolled in EvidenceNOW, and suggested that in these practices lower autonomy and greater complexity compared to clinician-owned ownership influenced facilitation participation patterns. CONCLUSIONS Practice ownership shaped how but not how much practices participated in external facilitation. This finding highlights the importance of tailoring facilitation approaches based on ownership-related characteristics in future QI initiatives.
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Affiliation(s)
- Cynthia K Perry
- School of Nursing, Oregon Health & Science University, Portland, OR, USA.
| | - Stephan Lindner
- Center for Health System Effectiveness, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Hall
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Andrea Baron
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Daei A, Soleymani MR, Ashrafi-Rizi H, Kelishadi R, Zargham-Boroujeni A. Personal, technical and organisational factors affect whether physicians seek answers to clinical questions during patient care: a literature review. Health Info Libr J 2020; 38:81-96. [PMID: 32686897 DOI: 10.1111/hir.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Numerous questions are generated for physicians during patient care. Facilitators and barriers affect the physicians' clinical information-seeking behaviour. While most health studies have focused on barriers, few have dealt with facilitators. OBJECTIVE This review aimed to identify facilitators in physicians' information-seeking behaviour to help respond to clinical questions raised during patient care. METHODS A narrative review was conducted, and 9 databases were searched. Selection criteria included original articles in the context of patient care and full-text articles published in the English language from 2002 to 2019. The articles were selected and analysed by group discussions. RESULTS Analysis of studies disclosed personal, technical and organisational facilitators including 26 themes. Internet utilisation and information searching skills, more available time, personal interests and knowing preferred sites or textbooks were among the personal factors. The most common technical factors included providing navigation support, and ease of searching and finding needed information. The most commonly reported factors at the organisational level are closeness to Internet facility and access during the consultation. CONCLUSION Information systems designers, health service managers and librarians may need to work together to provide systems and settings that encourage doctors to seek information to answer their clinical questions during patient care.
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Affiliation(s)
- Azra Daei
- Department of Medical Library and Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Soleymani
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Ashrafi-Rizi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Zargham-Boroujeni
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Davis J, Morgans A, Dunne M. Supporting adoption of the palliative approach toolkit in residential aged care: an exemplar of organisational facilitation for sustainable quality improvement. Contemp Nurse 2019; 55:369-379. [DOI: 10.1080/10376178.2019.1670708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jenny Davis
- College of Science Health & Engineering, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3082, Australia
| | - Amee Morgans
- Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mairead Dunne
- Monash Medical Centre, Wellington Rd, Clayton, VIC, Australia
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Moussa L, Garcia-Cardenas V, Benrimoj SI. Change Facilitation Strategies Used in the Implementation of Innovations in Healthcare Practice: A Systematic Review. JOURNAL OF CHANGE MANAGEMENT 2019. [DOI: 10.1080/14697017.2019.1602552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lydia Moussa
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | | - Shalom I. Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Leysen B, Van den Eynden B, Janssens A, Wens J. Recruiting general practitioners for palliative care research in primary care: real-life barriers explained. BMC FAMILY PRACTICE 2019; 20:40. [PMID: 30836994 PMCID: PMC6399951 DOI: 10.1186/s12875-019-0930-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The implementation of early palliative care within a primary care setting is a recent academic topic. Recruiting General Practitioners (GPs) to participate in a palliative care study can be challenging. The pro-Spinoza project implemented a Care Pathway for Primary Palliative Care in 5 areas in Belgium. During this project, the feasibility of the recruitment of GPs and palliative care patients was evaluated. METHODS The recruitment process was recorded in detail via an electronic logbook combining quantitative and qualitative data. Quantitative recordings included the contact types and the number of contacts with eligible GPs and were analysed descriptively. Qualitative recordings included field notes with feedback from the GPs and other stakeholders and were thematically analysed starting from the Grol and Wensing framework for professional behaviour change. RESULTS Of 4065 eligible GPs working in 5 areas under research, 787 GPs (19%) were contacted individually, 398 GPs (9,8%) were contacted face-to-face and most of these 398 GPs showed high interest in the topic. 112 GPs (2,8%) signed the collaboration agreement, but finally only 65 GPs (1,6%) delivered at least a completed baseline-questionnaire. Despite the initial interest in participating, the unpredictable and busy daily workloads of the GPs, as well as inexperience with research protocols, impeded the ability of the GPs to fully engage in the study. This resulted in the high dropout rate. Participating GPs reported that they had underestimated the effort required to effectively participate in the project. CONCLUSIONS Recruitment of GPs to palliative care research is challenging. Primary care is a vital service to engage in palliative care research however the practical limitations reduce the ability of the service to effectively engage in the research. More research is needed to determine how GPs might be better supported in research. TRIAL REGISTRATION ClinicalTrials.gov, NCT02266069 , Registered 16th October 2014, retrospectively registered.
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Affiliation(s)
- B. Leysen
- Department of Primary and Interdisciplinary Care, Faculty of Health and Life Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp Belgium
| | - B. Van den Eynden
- Department of Primary and Interdisciplinary Care, Faculty of Health and Life Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp Belgium
- Multidisciplinary Pain Centre, Antwerp University Hospital, Antwerp, Belgium
| | - A. Janssens
- Department of Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - J. Wens
- Department of Primary and Interdisciplinary Care, Faculty of Health and Life Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp Belgium
- Multidisciplinary Pain Centre, Antwerp University Hospital, Antwerp, Belgium
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6
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Due TD, Thorsen T, Waldorff FB, Kousgaard MB. Role enactment of facilitation in primary care - a qualitative study. BMC Health Serv Res 2017; 17:593. [PMID: 28835276 PMCID: PMC5569467 DOI: 10.1186/s12913-017-2537-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/14/2017] [Indexed: 12/05/2022] Open
Abstract
Background Facilitation 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. Methods The 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. Results The 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. Conclusion Facilitation 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.
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Affiliation(s)
- Tina Drud Due
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Thorkil Thorsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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7
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Cranley LA, Cummings GG, Profetto-McGrath J, Toth F, Estabrooks CA. Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review. BMJ Open 2017; 7:e014384. [PMID: 28801388 PMCID: PMC5724142 DOI: 10.1136/bmjopen-2016-014384] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/30/2016] [Accepted: 02/21/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Implementing research findings into practice is a complex process that is not well understood. Facilitation has been described as a key component of getting research findings into practice. The literature on facilitation as a practice innovation is growing. This review aimed to identify facilitator roles and to describe characteristics of facilitation that may be associated with successful research use by healthcare professionals. METHODS We searched 10 electronic databases up to December 2016 and used predefined criteria to select articles. We included conceptual papers and empirical studies that described facilitator roles, facilitation processes or interventions, and that focused on healthcare professionals and research use. We used content and thematic analysis to summarise data. Rogers' five main attributes of an innovation guided our synthesis of facilitation characteristics. RESULTS Of the 38 488 articles identified from our online and manual search, we included 195 predominantly research studies. We identified nine facilitator roles: opinion leaders, coaches, champions, research facilitators, clinical/practice facilitators, outreach facilitators, linking agents, knowledge brokers and external-internal facilitators. Fifteen facilitation characteristics were associated with research use, which we grouped into five categories using Rogers' innovation attributes: relative advantage, compatibility, complexity, trialability and observability. CONCLUSIONS We found a diverse and broad literature on the concept of facilitation that can expand our current thinking about facilitation as an innovation and its potential to support an integrated, collaborative approach to improving healthcare delivery.
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Affiliation(s)
- Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | | - Ferenc Toth
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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Sawatzky R, Porterfield P, Roberts D, Lee J, Liang L, Reimer-Kirkham S, Pesut B, Schalkwyk T, Stajduhar K, Tayler C, Baumbusch J, Thorne S. Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis. ANS Adv Nurs Sci 2016; 40:261-277. [PMID: 27930401 PMCID: PMC5555976 DOI: 10.1097/ans.0000000000000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Pat Porterfield
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Della Roberts
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Leah Liang
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sheryl Reimer-Kirkham
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Barb Pesut
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Tilly Schalkwyk
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Carolyn Tayler
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sally Thorne
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
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Lessard S, Bareil C, Lalonde L, Duhamel F, Hudon E, Goudreau J, Lévesque L. External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change. Implement Sci 2016; 11:97. [PMID: 27424171 PMCID: PMC4947272 DOI: 10.1186/s13012-016-0458-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
Background Facilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.’s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors. Methods We carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group’s site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics. Results A non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: “implementation-oriented” and “support-oriented.” Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors. Conclusions Facilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0458-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Céline Bareil
- HEC Montréal, Montreal, Canada. .,CETO (Center for Research in Organizational Transformation), Pôle Santé, HEC Montréal, Montreal, Canada.
| | - Lyne Lalonde
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,CHUM Research Center (CRCHUM), Université de Montréal, Montreal, Canada.,Sanofi Aventis endowment chair in ambulatory pharmaceutical care, Université de Montréal, Montreal, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, Canada
| | - Fabie Duhamel
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Eveline Hudon
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Johanne Goudreau
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Lise Lévesque
- Primary Care Research Team, Centre de santé et de services sociaux de Laval, Laval, Canada
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10
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Sawatzky R, Porterfield P, Lee J, Dixon D, Lounsbury K, Pesut B, Roberts D, Tayler C, Voth J, Stajduhar K. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC Palliat Care 2016; 15:5. [PMID: 26772180 PMCID: PMC4715271 DOI: 10.1186/s12904-016-0076-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. Methods We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach. Results The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Conclusion Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
| | - Pat Porterfield
- School of Nursing, University of British Columbia, T-201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Duncan Dixon
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Kathleen Lounsbury
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Barbara Pesut
- School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Della Roberts
- Fraser Health, Delta Hospital, Hospice Palliative Care, 5800 Mountain View Blvd, Delta, BC, V4K 3V6, Canada
| | - Carolyn Tayler
- Fraser Health, Suite 400-Central City Tower, 13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - James Voth
- Intogrey Research and Development Inc., 300-34334 Forrest Terrace, Abbotsford, BC, V2S 1G7, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Berta W, Cranley L, Dearing JW, Dogherty EJ, Squires JE, Estabrooks CA. Why (we think) facilitation works: insights from organizational learning theory. Implement Sci 2015; 10:141. [PMID: 26443999 PMCID: PMC4596304 DOI: 10.1186/s13012-015-0323-0] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Facilitation is a guided interactional process that has been popularized in health care. Its popularity arises from its potential to support uptake and application of scientific knowledge that stands to improve clinical and managerial decision-making, practice, and ultimately patient outcomes and organizational performance. While this popular concept has garnered attention in health services research, we know that both the content of facilitation and its impact on knowledge implementation vary. The basis of this variation is poorly understood, and understanding is hampered by a lack of conceptual clarity. Discussion In this paper, we argue that our understanding of facilitation and its effects is limited in part by a lack of clear theoretical grounding. We propose a theoretical home for facilitation in organizational learning theory. Referring to extant literature on facilitation and drawing on theoretical literature, we discuss the features of facilitation that suggest its role in contributing to learning capacity. We describe how facilitation may contribute to generating knowledge about the application of new scientific knowledge in health-care organizations. Summary Facilitation’s promise, we suggest, lies in its potential to stimulate higher-order learning in organizations through experimenting with, generating learning about, and sustaining small-scale adaptations to organizational processes and work routines. The varied effectiveness of facilitation observed in the literature is associated with the presence or absence of factors known to influence organizational learning, since facilitation itself appears to act as a learning mechanism. We offer propositions regarding the relationships between facilitation processes and key organizational learning concepts that have the potential to guide future work to further our understanding of the role that facilitation plays in learning and knowledge generation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0323-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Whitney Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario, M5T 3M6, Canada.
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - James W Dearing
- College for Communication Arts & Sciences, Michigan State University, East Lansing, Michigan, USA.
| | - Elizabeth J Dogherty
- St. Paul's Hospital, Providence Health Care, Vancouver, British Columbia, Canada.
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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 FAMILY PRACTICE 2015. [PMID: 26224104 PMCID: PMC4520205 DOI: 10.1186/s12875-015-0298-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Practice facilitation is a key component of quality improvement in primary healthcare. Studies have reported the effectiveness of practice facilitation in improving quality management and care delivery. However, little has been published about practice facilitators' training, facilitation activities, and their perceived role in quality improvement in primary healthcare. This study examined practice facilitators' training and the perceptions of the practice facilitator role in a provincial primary healthcare learning collaborative quality improvement initiative in Ontario, Canada. METHOD Descriptive and qualitative methods were used to outline the practice facilitator training as well as to look into the experiences and perceptions of practice facilitators and primary healthcare teams regarding the practice facilitation role in quality improvement. Data collection included training artifacts, activity logs, self-reflection reports, and semi-structured interviews with practice facilitators and primary healthcare participants. Reflections and interviews were analyzed to identify the role of the practice facilitators from their own experience, and from the perspective of the participants. Descriptive statistics were used to learn about categories of facilitation activities undertaken and frequency of these activities. RESULTS Sixteen practice facilitators and seven family healthcare teams participated in the study. Practice facilitators received a two-day intensive training workshop and continued training. Their time was spent mostly working directly with participating teams, continued learning and training, communications and administration. They served as coaches, resource providers, enablers and motivators. Participating teams expressed satisfaction with the practice facilitator role, although they had hoped this position would provide onsite and hands-on support in conducting activities of quality improvement at the practice level. CONCLUSIONS Practice facilitators played a crucial role in the implementation of quality improvement in Ontario's learning collaborative program. The practice facilitator role is perceived to be that of a coach, enabler and motivator. This study suggests that the practice facilitator successfully supported participating teams to undertake quality improvement activities in primary healthcare settings.
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Affiliation(s)
- Jyoti Kotecha
- Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada.
| | - Han Han
- Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada.
| | - Michael Green
- Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada.
| | - Grant Russell
- Southern Academic Primary Care Research Unit, School of Primary HealthCare, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Mary I Martin
- Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada.
| | - Richard Birtwhistle
- Department of Family Medicine, Centre for Studies in Primary Care, School of Medicine, Queen's University, 220 Bagot Street, P.O. Bag 8888, Kingston, Ontario, K7L 5E9, Canada.
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Due TD, Thorsen T, Kousgaard MB, Siersma VD, Waldorff FB. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice: a stepped-wedge randomised controlled trial. BMC FAMILY PRACTICE 2014; 15:65. [PMID: 24716545 PMCID: PMC4234362 DOI: 10.1186/1471-2296-15-65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Abstract
Background The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention. Method The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics. The control group was a delayed intervention group. The primary outcome was change in the number of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2 diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and reduction in number of practices with few annual chronic disease check-ups. Results We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the delayed intervention group. For the primary outcome, 94 and 89 practices were analysed. Almost every outcome improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention: a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification for COPD (p = 0.0185) and a faster initial sign-up rate for the software program. Conclusion The mixed results from this study indicate that a semi-tailored facilitator-based intervention of relatively low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry participation) aimed at moving all practices towards changes in chronic care. Trial registration ClinicalTrials.gov: NCT01297075
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Affiliation(s)
- Tina Drud Due
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Liddy CE, Blazhko V, Dingwall M, Singh J, Hogg WE. Primary care quality improvement from a practice facilitator's perspective. BMC FAMILY PRACTICE 2014; 15:23. [PMID: 24490746 PMCID: PMC3931473 DOI: 10.1186/1471-2296-15-23] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Practice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change. METHODS We conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007-2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts. RESULTS Common barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility. CONCLUSIONS The consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions.
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Affiliation(s)
- Clare E Liddy
- C,T, Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
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Urquhart R, Sargeant J, Grunfeld E. Exploring the usefulness of two conceptual frameworks for understanding how organizational factors influence innovation implementation in cancer care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2013; 33:48-58. [PMID: 23512560 DOI: 10.1002/chp.21165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Moving knowledge into practice and the implementation of innovations in health care remain significant challenges. Few researchers adequately address the influence of organizations on the implementation of innovations in health care. The aims of this article are to (1) present 2 conceptual frameworks for understanding the organizational factors important to the successful implementation of innovations in health care settings; (2) discuss each in relation to the literature; and (3) briefly demonstrate how each may be applied to 3 initiatives involving the implementation of a specific innovation-synoptic reporting tools-in cancer care. Synoptic reporting tools capture information from diagnostic tests, surgeries, and pathology examinations in a standardized, structured manner and contain only the information necessary for patient care. The frameworks selected were the Promoting Action on Research Implementation in Health Services framework and an organizational framework of innovation implementation; these frameworks arise from different disciplines (nursing and management, respectively). The constructs from each framework are examined in relation to the literature, with each construct applied to synoptic reporting tool implementation to demonstrate how each may be used to inform both practice and research in this area. By improving our understanding of existing frameworks, we enhance our ability to more effectively study and target implementation processes.
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Affiliation(s)
- Robin Urquhart
- Knowledge Broker, Cancer Outcomes Research Program, Cancer Care Nova Scotia, and Interdisciplinary PhD Program, Dalhousie University, Halifax, NS B3H 2Y9.
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Lundstrøm LH, Johnsen AT, Ross L, Petersen MA, Groenvold M. Cross-sectorial cooperation and supportive care in general practice: cancer patients' experiences. Fam Pract 2011; 28:532-40. [PMID: 21427204 DOI: 10.1093/fampra/cmr011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients' experiences of continuity and support may be related to characteristics of health care, disease or patients. OBJECTIVES To investigate Danish cancer patients' experiences of their contact to the GP and the cooperation between the GP and the hospital. METHODS A national cross-sectional questionnaire study in three representative counties of Denmark. Based on a review of medical records from all hospital departments treating cancer patients, a random sample of 1490 patients completed a validated questionnaire regarding patient experiences. A mixed methods approach was applied. Associations between patient experiences and background variables were analysed in ordinal logistic regression models and patients' written comments were analysed qualitatively. RESULTS One-third of the patients evaluated the cooperation between hospitals and primary care as suboptimal. Younger patients and patients from the capital Copenhagen were most dissatisfied. A third had needed support from their GP, and 41% of these patients had not fully received what they needed. Older patients, patients in Stage 1 and patients from surgical departments were least likely to have needed their GP's support. Patients described support from the GP as empathic behaviour and help with coordinating health services. CONCLUSIONS A substantial number of cancer patients experienced suboptimal cross-sectorial cooperation and supportive care. Efforts to improve cancer care cooperation may focus on the possible supportive role of the GP as it seems that there is an untapped potential in primary care.
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Affiliation(s)
- Louise Hyldborg Lundstrøm
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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