Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration
Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration
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DOI：
10.1186/s13012-015-0252-y
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发表时间：
2015-05-14
影响因子：
7.2
通讯作者：
Damush, Teresa M.
中科院分区：
文献类型：
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作者：
Bidassie, Balmatee;Williams, Linda S.;Damush, Teresa M.
工作背景：在若干执行框架中，便利化是成功执行的一个关键组成部分;然而，具体说明这一组成部分的研究很少。作为退伍军人健康管理局（VHA）中风质量改善干预的一部分，在11个VA医疗机构中将促进加数据反馈与单独的数据反馈进行了比较。本研究的目的是阐明中风quality improvement.Methods的促进成分：我们进行了二次评价，使用半结构化访谈的外部促进。五名主持人和两名项目主任接受了采访。定性分析进行转录访谈，以了解在现场和电话促进的作用和外部促进者的活动。定量频率计算从自我报告的时间花费在促进tasks由facilitators.Results：外部促进者认为他们的作用，授权的临床团队采取的过程中的变化，在临床站点，以提高他们的性能质量的所有权。为了履行这一职责，他们报告说，在电话和现场访问期间参与了一些核心任务，包括：评估团队目前运作的环境，指导临床团队进行计划的变更和使用流程改进工具，确定资源并进行转介，通过现场访问让团队对计划实施负责，并为团队提供支持和鼓励。从指导变化（早期）到支持临床团队所做的努力（后期），促进活动所花费的时间随着时间的推移而变化。促进活动转变为更多的监测、问题解决和有意识的工作，将临床改进过程移交给研究中心团队，教练的角色越来越像一个更遥远的顾问。总体而言，这项研究表明，外部促进是不是一个事件，而是一个过程中的关系和责任随着时间的推移evolved.Conclusions：这项研究表明，外部促进涉及到沟通，关系建设，方法培训，随着时间的推移，监测性能，促进团队为基础的问题解决的核心要素。重要的是，这项工作证明了随着时间的推移，外部促进的流动性，因为团队学习，成长，变化和经验不断变化的环境。
Background: Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement.Methods: We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators.Results: The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach's role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not an event but rather a process where relationships and responsibilities evolve over time.Conclusions: This study shows that external facilitation involves core elements related to communication, relationship building, methods training, monitoring performance over time, and facilitating team-based problem solving. Importantly, this work demonstrates the fluid nature of external facilitation over time, as teams learn, grow, change, and experience changing contexts.