Due Tina Drud, Thorsen Thorkil, Waldorff Frans Boch, Kousgaard Marius Brostrøm
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.
BMC Health Serv Res. 2017 Aug 23;17(1):593. doi: 10.1186/s12913-017-2537-0.
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.
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.
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.
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.
促进是质量改进中广泛使用的实施方法。综述揭示了对促进及促进者角色的多种理解。研究表明，促进干预应具有灵活性，并根据接受组织的需求和情况进行调整。促进领域的复杂性和潜在促进者角色的多样性促使人们需要详细研究促进是如何实施的。因此，本研究的目的是探讨外部同行促进在全科医疗中的实施情况，以便为将促进作为一种实施方法进行讨论和完善创造更坚实的基础。
所研究的促进干预在丹麦首都地区的全科医疗中进行，以支持实施慢性病管理项目的总体战略。我们在13个实践场所观察了30次促进访问，并与促进者进行了访谈和焦点小组讨论。我们在数据收集和分析中采用了探索性方法，并进行了归纳主题分析。
促进者主要扮演了四种促进者角色：教师、超级用户、同行和流程管理者。因此，除了努力保持过程的结构化和重点突出外，促进者还进行了教学演示和实践学习，因为他们试图传递事实信息和基于经验的知识，以及他们自己对实施实践变革的热情。虽然在扮演这些角色时偶尔会遇到挑战，但更重要的是，我们发现干预设计中设想的基于指导的角色很少被实施，这意味着促进者在促进访问期间没有促成大量的内部小组讨论。
促进在概念和实践上都是一个复杂的现象。本研究通过展示促进可以以多种方式实施，并表明根据背景、干预设计和促进者的专业背景，某些促进者角色比其他角色更有可能被实施，对现有研究进行了补充。这种复杂性在比较和评估促进研究时需要谨慎，并突出了在设计、实施和报告促进干预时，对目标、角色和能力需要精确和明确。
