Table 4 The external facilitator role in problem identification/resolution: potential activities/behaviors per QUERI experiences

   a) Identification and clarification of problems related to implementing both the evidence-based practices and related implementation interventions

i) Provides and reviews with the ICA (internal change agent) information on current gaps, identified barriers, and other feedback

ii) Helps ICAs understand their own situation and the nature of problems within their culture/context/work language.

(1) Note: Requires the external facilitator to assess and understand the local context.

iii) Defines and frames a user's problem in a way that the ICA can best deal with it.

   b) Review of potential approaches for problem resolution

i) Shares viable solutions/options with ICA/s.

(1) Seeks information and answers within the greater VA system, including other implementation sites.

(2) Works with the QUERI project team to help develop viable alternative activities to solve site problems and remove complex barriers.

ii) Helps ICA/s figure out appropriate strategies to address barriers.

iii) Creates opportunities for resolution/actions by the ICA, e.g., by:

(1) Identifying experts,

(2) Identifying peer sites,

(3) Identifying resources in the VA, and

(4) Establishing a link between the ICA and potential problem solver/s in VA.

iv) Negotiates appropriate solutions with the internal agent, as needed.

   c) Assistance in setting clear goals.

i) Helping ICA/s set realistic goals to overcome problems and achieve evidence-based practice targets.

   d) Direct implementation or initiation of solutions in relation to both identified local site needs and the need to see core QUERI intervention strategies implemented:

(1) When specific expertise or skill is required,

(a) Provides more education, e.g., re: the implementation strategies or the targeted evidence, and

(b) Generates needed tools or sample materials.

(2) When specific networking or external contacts are required,

(a) For example, obtains available resources for the ICA/s or sites.