Abstract
BackgroundImplementation facilitators enable healthcare staff to effectively implement change, yet little is known about their affective (e.g., emotional, mental, physical) experiences of facilitation. We propose an expansion to the Integrated Promoting Action on Research in Health Services (i-PARIHS) framework that introduces facilitation intensity and facilitator resilience to better assess facilitators’ affective experiences.MethodsWe used an instrumental case study and facilitator data (logged reflections and debrief session notes) from the Coordination Toolkit and Coaching initiative to conceptualize facilitation intensity and facilitator resilience and to better understand the psychological impact of the facilitation process on facilitator effectiveness and implementation success.ResultsWe define facilitation intensity as both the quantitative and/or qualitative measure of the volume of tasks and activities needed to engage and motivate recipients in implementation, and the psychological impact on the facilitator of conducting facilitation tasks and activities. We define facilitator resilience as the ability to cope with and adapt to the complexities of facilitation in order to effectively engage and motivate staff, while nurturing and sustaining hope, self-efficacy, and adaptive coping behaviors in oneself.ConclusionsFacilitators’ affective experience may help to identify potential relationships between the facilitation factors we propose (facilitation intensity and facilitator resilience). Future studies should test ways of reliably measuring facilitation intensity and facilitator resilience and specify their relationships in greater detail. By supporting facilitator resilience, healthcare delivery systems may help sustain the skilled facilitator workforce necessary for continued practice improvement.Trial registrationThe project was registered with ClinicalTrials.gov (NCT03063294) on February 24, 2017.
Highlights
Implementation facilitators enable healthcare staff to effectively implement change, yet little is known about their affective experiences of facilitation
Facilitators have been effective in improving the adoption of evidence-based guidelines in primary care settings [9,10,11,12], and in supporting quality improvement (QI) [13,14,15]
We review the i-PARIHS framework, present a case study that illustrates two distinct elements of facilitation that have not been fully specified in previous studies, and propose an expanded conceptual framework that better reflects facilitators’ affective experiences
Summary
Implementation facilitators enable healthcare staff to effectively implement change, yet little is known about their affective (e.g., emotional, mental, physical) experiences of facilitation. We propose an expansion to the Integrated Promoting Action on Research in Health Services (i-PARIHS) framework that introduces facilitation intensity and facilitator resilience to better assess facilitators’ affective experiences. Implementation facilitators are individuals trained to enable recipients of an innovation to effectively implement change in multiple settings [2]. The Integrated Promoting Action on Research in Health Services (i-PARIHS) implementation framework, the most commonly used theoretical framework for understanding facilitation in implementation science [16], defines facilitation as the role and strategies used to enable implementation and the “active ingredient” that brings together an innovation, its recipients, and context to achieve successful implementation (see Fig. 1) [16]. We review the i-PARIHS framework, present a case study that illustrates two distinct elements of facilitation (facilitation intensity and facilitator resilience) that have not been fully specified in previous studies, and propose an expanded conceptual framework that better reflects facilitators’ affective experiences
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