Capacity Coaching: A Focused Ethnographic Evaluation in Clinical Practice

Kasey R Boehmer,Nilay D Shah,Kathryn Havens,Anjali Thota,Paige Organick

doi:10.1016/j.mayocpiqo.2019.11.002

Abstract

ObjectiveTo qualitatively evaluate the implementation of Capacity Coaching, an intervention to address the work patients must undertake to manage their conditions, implemented as a quality improvement pilot in 1 of 2 implementing US Department of Veterans Affairs medical centers.Participants and MethodsTwo Veterans Affairs medical centers in the Midwest sought to implement Capacity Coaching as a quality improvement pilot in their Patient-Aligned Care Teams for 6 months (April 1, 2017, through October 31, 2017). Following the pilot, we conducted a focused ethnographic evaluation (on-site data collection, January 2-4, 2018), including interviews, a focus group, and observations with staff at one site to assess the implementation of capacity coaching. Data were analyzed inductively and findings were cross-referenced with implementation theory.ResultsWe found that implementation was feasible and achieved changes that were aligned with reducing patient work and increasing capacity. We found that the key facilitators for the implementation of this program were in participants making sense of the intervention (coherence) and working collectively to enact the program (collective action). The main challenges for the program were in planning the work of implementation and enrolling a diverse coalition of staff to expand referrals to the program (cognitive participation) and in evaluating the impact of the program on outcomes that upper leadership was interested in (reflexive monitoring).ConclusionImplementation of Capacity Coaching is feasible in clinical practice and may be a promising intervention for the care of chronic conditions. Further research should focus on testing capacity coaching using these lessons learned.

Highlights

PARTICIPANTS AND METHODS Two US Department of Veterans Affairs (VA) medical centers in the Midwest sought to implement capacity coaching as a quality improvement pilot initiative in their PatientAligned Care Teams (PACTs)
During planning and the early pilot, it became apparent that site 1 could be best served by a peer support specialists (PSSs) as the capacity coach because patients placed value on the shared life experience of a female veteran living with chronic illness
The program’s implementation challenges were in planning the work of implementation and enrolling a diverse coalition of clinical staff to expand referrals to the program and in evaluating the impact of the program on outcomes that upper leadership was interested in to continue the program beyond the grant funding period

Summary

PARTICIPANTS AND METHODS

The workshop content was delivered over a single-day 8-hour session It included training on MDM and its conceptual and theoretical models, the ICAN Discussion Aid, Capacity Coaching principles, and implementation in complex systems. Artifacts provided by the team to the lead author included the final version of the implementation toolkit, workbook materials for coach-patient interactions, and template tools for documenting capacity coaching in the medical record. The lead author summarized all data into key themes found in the culture of the clinic, using CuCoM, NPT, and TPC This step represents the use of well-fitting existing conceptual models and theories to organize the data after initial analyses in a manner that is useful for the translation of interventions into practice and is respected as useful for meeting challenges in implementation of complex interventions.[12,14]

RESULTS

Limitations and Strengths

CONCLUSION