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Smith JL, Spollen JJ, Owen RR. Facilitation in Implementing Evidence-Based Practices for Schizophrenia: Researcher & Clinical Leader Perspectives. Paper presented at: University of Alberta Knowledge Translation Annual Forum; 2008 Jun 12; Alberta, Canada.
Research Objective: The PARiHS framework has defined 'facilitation' as "a technique by which one person makes things easier for others", encompassing a range of approaches from task-focused to enabling processes. Based on experiences in the Veterans Health Administration (VHA) QUERI program, facilitation has been described as "a process of interactive problem-solving and support to meet specific implementation goals, which occurs in the context of a recognized need for improvement and a supportive interpersonal relationship." This abstract reports researcher and clinical leader perspectives on external facilitation utilized in a VHA Mental Health QUERI project to improve antipsychotic medication management for patients with schizophrenia. Study Design: Descriptive case study of external facilitation applied by researchers in partnership with mental health clinicians implementing a multi-component, team-based quality improvement (QI) intervention to improve antipsychotic dosing and side effect monitoring Principal Findings: The external facilitator maintained regular contact with the QI team to monitor implementation of project tools/strategies, identify barriers, problem-solve, and assist in adapting tools/strategies as needed. Facilitation resulted in placement of recommendations for antipsychotic dosing and side effect monitoring on medication order screens, performance reports tailored to clinician preferences, and development of weekly reports identifying patients in need of metabolic side effect monitoring. Metabolic side effect monitoring was considerably improved, resulting in the medical center achieving administrative performance targets for antipsychotic side effect monitoring for the first time. Project tools continue to be utilized and monitoring improvements have been sustained. From the researcher perspective, lessons learned include: (1) external facilitators need to be flexible to accommodate suggestions of clinical partners for modifying tools/strategies when initial efforts have limited success, (2) rapid response to clinical partner concerns is optimal but not always feasible due to time/availability issues; and (3) there is a need to establish boundaries for what facilitators will and will not do for clinical partners to minimize potential for misunderstandings. From the clinical leader perspective, external facilitation: (1) placed too much initial emphasis on educational strategies; and (2) encouraged innovation to emerge from within the clinical team by actively eliciting and responding to feedback on needed refinements/augmentations to intervention tools. Conclusions: External facilitation may foster collaborative relationships between researchers and clinicians to encourage the adoption and sustained implementation of evidence-based practices. Although the content of facilitation may vary for different projects in different contexts, the process of external facilitation may be a generalizable approach researchers can use to successfully implement evidence-based care in routine clinical settings.
