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Role enactment of facilitation in primary care - a qualitative study.
Due, Tina Drud; Thorsen, Thorkil; Waldorff, Frans Boch; Kousgaard, Marius Brostrøm.
Afiliación
  • Due TD; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. tina.due@sund.ku.dk.
  • Thorsen T; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
  • Waldorff FB; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
  • Kousgaard MB; Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
BMC Health Serv Res ; 17(1): 593, 2017 Aug 23.
Article en En | MEDLINE | ID: mdl-28835276
BACKGROUND: Facilitation is a widely used implementation method in quality improvement. Reviews reveal a variety of understandings of facilitation and facilitator roles. Research suggests that facilitation interventions should be flexible and tailored to the needs and circumstances of the receiving organisations. The complexity of the facilitation field and diversity of potential facilitator roles fosters a need to investigate in detail how facilitation is enacted. Hence, the purpose of this study was to explore the enactment of external peer facilitation in general practice in order to create a stronger basis for discussing and refining facilitation as an implementation method. METHODS: The facilitation intervention under study was conducted in general practice in the Capital Region of Denmark in order to support an overall strategy for implementing chronic disease management programmes. We observed 30 facilitation visits in 13 practice settings and had interviews and focus groups with facilitators. We applied an explorative approach in data collection and analysis, and conducted an inductive thematic analysis. RESULTS: The facilitators mainly enacted four facilitator roles: teacher, super user, peer and process manager. Thus, apart from trying to keep the process structured and focused the facilitators were engaged in didactic presentations and hands-on learning as they tried to pass on factual information and experienced based knowledge as well as their own enthusiasm towards implementing practice changes. While occasional challenges were observed with enacting these roles, more importantly we found that a coaching based role which was also envisioned in the intervention design was only sparsely enacted meaning that the facilitators did not enable substantial internal group discussions during their facilitation visits. CONCLUSION: Facilitation is a complex phenomenon both conceptually and in practice. This study complements existing research by showing how facilitation can be enacted in various ways and by suggesting that some facilitator roles are more likely to be enacted than others, depending on the context and intervention design and the professional background of the facilitators. This complexity requires caution when comparing and evaluating facilitation studies and highlights a need for precision and clarity about goals, roles, and competences when designing, conducting, and reporting facilitation interventions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Enfermedad Crónica / Mejoramiento de la Calidad / Implementación de Plan de Salud Tipo de estudio: Qualitative_research / Sysrev_observational_studies Aspecto: Implementation_research Límite: Humans País/Región como asunto: Europa Idioma: En Revista: BMC Health Serv Res Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE Año: 2017 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Enfermedad Crónica / Mejoramiento de la Calidad / Implementación de Plan de Salud Tipo de estudio: Qualitative_research / Sysrev_observational_studies Aspecto: Implementation_research Límite: Humans País/Región como asunto: Europa Idioma: En Revista: BMC Health Serv Res Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE Año: 2017 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Reino Unido