Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Australia.
School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology , Kelvin Grove, Australia.
J Health Organ Manag. 2019 Mar 18;33(1):78-92. doi: 10.1108/JHOM-03-2018-0071. Epub 2018 Oct 30.
The purpose of this paper is to advance understanding about the facilitation process used in complex implementation projects, by describing the function of novice clinician facilitators, and the barriers and enablers they experience, while implementing a new model of care for managing hospital malnutrition.
DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were undertaken with local facilitators ( n=7) involved in implementing The SIMPLE Approach (Systematised Interdisciplinary Malnutrition Pathway Implementation and Evaluation) in six hospitals in Queensland, Australia. Facilitator networks and training supported the clinicians acting as novice facilitators.
Key functions of the facilitator role were building relationships and trust; understanding the problem and stimulating change through data; negotiating and implementing the change; and measuring, sharing and reflecting on success. "Dedicated role, time and support" was identified as a theme encompassing the key barriers and enablers to successful facilitation.
When implementing complex interventions within short project timelines, it is critical that novice clinician facilitators are given adequate and protected time within their role, and have access to regular support from peers and experienced facilitators. With these structures in place, facilitators can support iterative improvements through building trust and relationships, co-designing strategies with champions and teams and developing internal capacity for change.
ORIGINALITY/VALUE: This case study extends the knowledge about how facilitation works in action, the barriers faced by clinicians new to working in facilitator roles, and highlights the need for an adapt-to-fit approach for the facilitation process, as well as the innovation itself.
本文旨在通过描述新手临床医师促进者的职能，以及他们在实施管理医院营养不良的新护理模式时所面临的障碍和促进因素，来深入了解在复杂实施项目中使用的促进过程。
设计/方法/途径：对参与在澳大利亚昆士兰州的六家医院实施 SIMPLE 方法（系统的跨学科营养不良途径实施和评估）的当地促进者（n=7）进行了半结构化访谈。促进者网络和培训支持了作为新手促进者的临床医生。
促进者角色的主要职能包括建立关系和信任；通过数据了解问题并激发变革；协商和实施变革；以及衡量、分享和反思成功。“专门的角色、时间和支持”被确定为成功促进的关键障碍和促进因素的主题。
当在短项目时间内实施复杂干预措施时，新手临床医师促进者在其角色中获得足够和受保护的时间，以及定期获得同行和经验丰富的促进者的支持至关重要。有了这些结构，促进者可以通过建立信任和关系、与拥护者和团队共同设计策略以及发展内部变革能力来支持迭代改进。
原创性/价值：本案例研究扩展了关于促进在实践中如何运作、临床医生在新的促进者角色中面临的障碍的知识，并强调了适应促进过程以及创新本身的必要性。
