Stetler Cheryl B, Legro Marcia W, Rycroft-Malone Joanne, Bowman Candice, Curran Geoffrey, Guihan Marylou, Hagedorn Hildi, Pineros Sandra, Wallace Carolyn M
Implement Sci. 2006 Oct 18;1:23. doi: 10.1186/1748-5908-1-23.
Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system - the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs.
A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis.
Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other implementation interventions, while performing this problem-solving and supportive role. PRELIMINARY CONCLUSIONS: This evaluation provides evidence to suggest that facilitation could be considered a distinct implementation intervention, just as audit and feedback, educational outreach, or similar methods are considered to be discrete interventions. As such, facilitation should be well-defined and explicitly evaluated for its perceived usefulness within multi-intervention implementation projects. Additionally, researchers should better define the specific contribution of facilitation to the success of implementation in different types of projects, different types of sites, and with evidence and innovations of varying levels of strength and complexity.
在文献中，促进被视为成功实施的一个潜在关键要素。然而，它既未得到明确界定，也未得到充分研究。关于促进的操作定义以及促进与其他干预措施的关系，尤其是在多层面实施项目中与其他变革推动者角色的关系，仍存在重大问题。作为质量提升研究计划（QUERI）一部分的研究人员正在积极探索各种方法和流程，包括促进，以推动美国最大的综合医疗系统——退伍军人健康管理局医疗系统中最佳实践的实施。本文描述了对QUERI内部与实施相关的促进经验进行的系统回顾性评估，QUERI是美国退伍军人事务部开展的一项质量改进计划。
通过一系列半结构化访谈进行事后评估，以考察多个多地点QUERI实施研究中的促进概念。访谈过程基于教育领域开发的一种技术，该技术通过激发对过去复杂活动的回忆和反思，系统地通过经验增强学习。针对一组基于概念的访谈问题，采用迭代内容分析方法进行数据分析。
结果表明，在由中央变革机构发起的实施研究中，促进是一个经过深思熟虑且有价值的互动式问题解决和支持过程，它发生在公认的改进需求和支持性人际关系的背景下。促进主要被描述为一个具有一些潜在关键行为和活动的独特角色。数据进一步表明，外部促进者在履行这一问题解决和支持角色时，可能会使用或整合其他实施干预措施。
该评估提供的证据表明，促进可被视为一种独特的实施干预措施，就如同审核与反馈、教育推广或类似方法被视为不同的干预措施一样。因此，在多干预实施项目中，应明确界定促进并对其感知的有用性进行明确评估。此外，研究人员应更好地界定促进在不同类型项目、不同类型地点以及不同强度和复杂性的证据与创新情况下对实施成功的具体贡献。
