Table 7 Barriers and facilitators of external facilitation per QUERI experiences
Facilitators* | Barriers |
|---|---|
Internal To The Implementation Sites | |
• Motivation for implementation | • Lack of motivation for implementation |
• Supportive leadership | • Lack of leadership support |
External to the Implementation Sites | |
• Sufficient contact with ICA** | • Insufficient contact with ICA |
• QUERI team that understands and supports the role | • Lack of understanding or operationalization of the role by the QUERI team |
• Facilitator skill/experience/attributes | • Inadequate facilitator skill/experience/attributes |
Sample Interviewee accounts | |
• "Some [sites] wanted to change and were ready ... this was a high priority for them." | |
• [A QUERI leader]... "being protective so the facilitators could do facilitation rather than project work...more explicitly, s/he 'made space' for the facilitators." | ◦ "The concept of facilitation really wasn't thought about in a formal manner ... Data was more on the mind of the study team." |
•" My training and background in group dynamics... and ability to be flexible." | |
• "I know it would be cost prohibitive to have an external person at every site, but that would be best. The teams need an external person to prod and answer questions." | ◦ "Not being able to be there; not knowing what they are going through is a problem" |
• "You need to ID the skills you need and hire the people that fit that profile and that people like. The facilitator needs to be really familiar with the work to be done, have charisma, and be able to inspire people to change." | ◦ "Lack of motivation; lack of activation; lack of buy-in by lead provider." |
• "The most important thing is the level of buy-in of the site lead provider. True of all cases. They always set the tone." | ◦ "Only working with very busy docs – it was an up hill battle. ...We felt 'in the dark' about what was happening. We hope that having nurses ... and clerks in this role, there will be more eyes and ears." |